Member Cancellation Request Form (Auto-Pay)

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Mailadresse *

First Name *

Last Name *

Phone Number *

Address

City

State

Zip Code

Reason for cancellation: *

Moving

Illness/Injury

Joining another studio

Studio Hours

Cleanliness

Loss of Interest

Financial Hardship

Poor Management

Lack of Use

Andet:

Påkrævet

Comments:

Terms

I understand that this membership must be terminated in writing by the primary member and accompanied
by all membership cards if applicable.

Prior to final termination of my membership, I understand that I must
pay any amount owed on my membership account with I Am Yoga Wellness Studio.

I understand that in order to make the termination of my membership effective a 30 day notice is required. In
which case I am responsible for the payment of the current month’s dues.

I understand and agree to the terms explained above.

Påkrævet

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