Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you a current, or former LifeBridge Health employee? *No, I am not a LifeBridge employeeYes, I am a current LifeBridge employeeYes, I am a former LifeBridge employeeReason for cancelling? (Choose ONLY ONE) *Lack of TimeMovingHealth ConcernsAlternative Form of ExerciseJoining a Different GymFinancial HardshipNo Longer a Part of Corporate Partnership ProgramDues IncreaseOtherPlease go into more detail about why you are cancelling your membership. *CheckboxesAvailability and type of equipmentAmenitiesCustomer Service/SupportGroup ExerciseCleanlinessValue Compared to Similar GymsLocationOtherPlease share your suggestions for improving member experience.I understand that I must cancel my membership BEFORE the 25th of the month for my cancellation to be effective this month. If cancelling for more than just yourself, a cancellation form must be completed for ALL family members. *I UnderstandE-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 *Submit
