LifeBridge Health & Fitness Membership Cancellation Request

LifeBridge Health & Fitness Membership Cancellation Request

Submit this form to request cancellation of your membership. Please complete all required fields.
Member Name

First NameLast Name
Email Address
example@example.com
Phone Number (Include Country Code)
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you a current or former LifeBridge Health employee?
Reason for Cancelling Membership

Other
Please provide more detail about your reason for cancelling.
Additional information helps us better understand and serve the needs of our members.
Which aspects of the gym influenced your decision to cancel? (Select all that apply)

Other
Do you have any suggestions to improve the member experience?
Acknowledgement
E-Signature
By typing in your legal name, you agree that your electronic signature is the legal equivalent of your manual signature on this form.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: