Membership Cancellation Form


MEMBERSHIP CANCELLATION FORM

Empower Fitness Lab requires a thirty (30) day notice to cancel any recurring membership on monthly autopay. You can find a copy of the cancellation policy agreement in your account profile. If you are not able to retrieve a copy, or would like us to provide one for you, please submit your request to admin@empowerfitnesslab.com.

After submitting and signing this cancellation form, it will be sent to a manager for review and approval. All information must be correct before this cancellation can be processed. 

 

Cancellation form submitted by: on October 16, 2019.

Current membership: billed at /month

Reason for cancellation:

Final EFT:  

Remaining class sessions:  

Termination Date:  

 

I, , acknowledge that the membership termination date and policies have been explained. I understand that any EFT’s remaining in the thirty (30) day period will be billed.  I understand I have until the class expiration date to utilize any unused class sessions and, after the class expiration date, will forfeit any remaining unused class sessions as my membership will no longer be active.

 

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Signature Certificate
Document name: Membership Cancellation Form
Unique Document ID: 3f72a1c471d1aa30b005869be757862ef09026cd
TimestampAudit
August 28, 2019 5:49 pm CDTMembership Cancellation Form Uploaded by Ryan Pontbriand - ryan@empowerfitnesslab.com IP 204.60.4.41
August 28, 2019 6:26 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 104.184.134.12
August 29, 2019 8:19 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 8:49 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 11:32 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 11:44 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 11:46 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 11:52 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 11:55 am CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 73.76.127.113
August 29, 2019 1:16 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 1:29 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 1:29 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 1:36 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 1:37 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 1:48 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 2:04 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41
August 29, 2019 2:10 pm CDTAlex Garcia - alex@empowerfitnesslab.com added by Ryan Pontbriand - ryan@empowerfitnesslab.com as a CC'd Recipient Ip: 204.60.4.41