Gym Membership Hardship Assistance Request Form
Please complete the Gym Membership Hardship Assistance Request Form to apply for temporary assistance due to financial hardship. All information provided will be used solely to evaluate your request.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Membership ID or Number
*
Type of Membership
*
Please Select
Individual
Family
Student
Senior
Other
Length of Membership (in years)
*
Reason for Requesting Hardship Assistance
*
Loss of employment
Medical expenses
Family emergency
Reduced income
Other
Duration of Assistance Requested
*
Please Select
1 month
2 months
3 months
Other
Current Employment Status
*
Employed full-time
Employed part-time
Unemployed
Self-employed
Student
Retired
Other
Please provide additional details about your financial hardship and any relevant information to support your request.
*
Submit Hardship Assistance Request
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