Termination Form Name First Last PhoneEmail Membership Type(Required) 60-Minute Benefits Program 90-Minute Benefits Program Reason for TerminationTerms & ConditionsThe monthly Benefits Program payments are nonrefundable. You understand that by signing below you are terminating your Benefits Program membership effective as of today's date. You will have 90 days to use any remaining accumulated sessions, after which all accumulated sessions will be forfeited from your account and your membership will be considered terminated. If you were to re-enroll in the Benefits Program, you would be seen as a new member.SignatureDate MM slash DD slash YYYY