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Membership Cancellation

Todays Date: December 26, 2024

Member Name:

Phone Number:

Email Address:

Membership Type:

Membership Start Date: Start Date

As stated in our Membership Agreement our cancellation policy asks for 10 days written notice before your membership cancellation. If the date signed is less then 10 days before the end of the month your membership cancellation will be the following month from the date signed.

Requested Cancellation Date:

Please choose the last day of the month that you would like to be charged. Ex. 11/30/24 would mean your last auto billing would be on 11/1/24.

Terms and Conditions of Membership Cancellation:

Early Termination Fee: If your cancellation request is before your one year membership start date, an early termination fee will apply:
- Gold Membership: $295
- Platinum Membership: $575

For Office Use Only

Membership/Plan ID: ____________________________

Membership Start Date: ____ / ____ / ____

Membership End Date: ____ / ____ / ____

Cancellation Processed By: ____________________________

Final Confirmation: By signing below, I confirm my request to cancel my Skinlogic Med Spa membership as of the specified date and agree to the terms and conditions listed above.

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Timestamp

Audit

November 2, 2024 3:29 pm PST

Membership Cancellation Uploaded by scott smith - scottsm8@gmail.com IP 67.168.123.88

November 30, 2024 12:04 pm PST

Membership Cancellation - infossc2001@gmail.com added by scott smith - scottsm8@gmail.com as a CC'd Recipient Ip: 67.168.123.88

December 3, 2024 3:38 am PST

Membership Cancellation - infossc2001@gmail.com added by scott smith - scottsm8@gmail.com as a CC'd Recipient Ip: 98.203.141.236

December 3, 2024 2:30 pm PST

Membership Cancellation - infossc2001@gmail.com added by scott smith - scottsm8@gmail.com as a CC'd Recipient Ip: 67.168.123.88