CANCELLATION FORM

MEMBERSHIP CANCELLATION FORM – 30 DAY NOTICE

Your account will be cancelled after the next billing cycle. We will cancel your draft automatically. A copy of this cancellation will be emailed to you for your records.

 Illness Financial Burden Moving Do Not Use Unsatisfied with Programs/Service (please comment) Joined Another Facility Other

 Excellent Good Average Poor
 Excellent Good Average Poor
 Excellent Good Average Poor
 Excellent Good Average Poor

 I understand that my membership will be canceled 30 days from the date this form was submitted. I understand that I will be charged a $50 cancellation fee if I am cancelling before the end of my contract date. I understand that I will be charged/debited one additional month, for the use of the facility during my 30 day cancellation period. Upon completion of the 30 day cancellation period, my membership shall then be considered terminated. Should I choose to rejoin Atlas after the termination of my membership, I will have to pay at the then current rate. I understand that if I am requesting to cancel my membership while it is on hold, that the membership will become active and the 30 day cancellation window will begin.