Name *

First Name

Last Name

Please select your membership cancellation policy below: *

6mth Direct Debit Membership - $85 instant cancelation OR 4 weeks of usual weekly payments during which time the member can continue using the facility as normal.

12mth Direct Debit Membership - $120 instant cancelation OR 6 weeks of weekly usual payments during which time the member can continue using the facility as normal.

18mth Direct Debit Membership - $150 instant cancelation OR 8 weeks of usual weekly payments during which time the member can continue using the facility as normal.

Preferred cancellation payment method; *

I would like to pay weekly and contiune using the gym as normal until my cancellation period ends.

I would like to pay in full and cancel immediately.

Please select your reason for cancellation; *

I have an injury and I'm not longer able to attend the gym.

I'm unable to maintain the financial commitment.

I'm moving out of town

I'd rather not say

Other (please provide further details below)

Please rate your experience with Tweak Fitness Tully 24/7, 10 being exceptional, 1 being not so good. *

10

8-10

5-7

2-4

1