OFFICE USE ONLY

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Links No:

Staff Name:
CANCELLATION REQUEST
POST 1 JULY 2017
I hereby authorise DOOLEYS Health and Fitness to CANCEL my gym membership
I hereby authorise DOOLEYS Health and Fitness to CANCEL my gym membership

Surname: First Name:

Preferred Name: Date of Birth: Email:

Address: Suburb/ Postcode:

Home Phone: Mobile:

Please tick what membership you are on:

Standard Family DD Offpeak PAYG Corporate Foundation Staff Junior

I am CANCELLING due to:

Demotivated Lack of Time Financial Issues Moving Overseas Moving out of area New Gym
Terrible Mediocre Fantastic!
Rate your overall Experience: 0 1 2 3 4 5 6 7 8 9 10

Please leave a comment about your experience:

Cancellation Terms, Conditions and Fees:

I understand that I must provide 30 days written notice in the form of this cancellation form and I am still liable for any directs debits that fall
within the notice period or outstanding fees that have accumulated over the membership period.

A direct debit membership can not be cancelled while the account is on hold. A member wishing to cancel their membership must come off hold
and give the appropriate 30 days notice to cancel.

CANCELLING WITHIN A 26 PAYMENT CONTRACT TERM

I understand that if I choose to cancel my membership within the agreed term, (minimum 26 fortnightly debits) an early exit fee of $200 will need
to be paid in full when submitting this form. I am aware of the terms and conditions stated on the Pre-exercise questionnaire form, which also apply.

CANCELLING OUT OF A CONTRACT TERM OR PAYG

CANCEL
I understand that if I choose to cancel my Pay-as-you-go membership, I am first required to pay a minimum of 2 payments. I am aware of the terms
and conditions stated on the Pre-exercise questionnaire form, which also apply.

<26 Payment Contract Number of agreed payments left Cancellation Fee Amount $
>26 Payments completed No Cancellation Fee
Cancelling within 7 Day Cooling Off Period No Cancellation Fee
PAYG No Cancellation Fee
Member Signature Print Name
Date

Office Use Only

Last Debit Date: Links Expiry Date: Staff Name:

Correct Entry Double checked by:

Staff Name: Date Checked:

CANCELLATION REQUEST
We understand that circumstances occur resulting in the need to cancel your gym membership.

Before filling out the cancelltion form, take the time to consider some other options on offer to get
you back on track to achieving your goals! Quitting isn’t always the best option.

PLEASE TICK A BOX TO MOVE FORWARD WITH YOUR REQUEST

STOP YOUR MEMBERSHIP FOR UP TO 12 WEEKS

You can pause your membership payments for up to 12 weeks.
Pausing your membership gives you the flexibility to take time off when it’s needed - whether it’s an
overseas trip, illness or just needing a break from training.
Conditions apply*

TRANSFER YOUR MEMBERSHIP TO A FRIEND OR FAMILY MEMBER

Know someone who has been thinking about joining DOOLEYS Health + Fitness? You can transfer your
membership straight to them, avoiding a possible cancellation fee and a great deal for your friend.
Conditions apply*

BOOK IN FOR A FREE SESSION WITH A TRAINER

Anyone can lose motivation and at times, cancelling your Gym membership might seem like the most
logical option. We’ll get you on track with a one-on-one session to get you back into routine and on
the way to success. See reception to book in for an appointment!

TRAIN WITH A FRIEND FOR 7 DAYS FOR FREE!

Make yourself accountable and re-commit to your goals with a friend using this 7 Day Pass. Research
has proven that you’re more likely to fulfill your goals if you train with a friend!
Conditions apply*

If none of these options suit and you still wish to cancel your membership, please tick this box and fill
out the cancellation form on the other side of this page.