MEMBER MOVE OF RESIDENCE CANCELLATION FORM
In order to cancel your membership due to your move of residence, all you need to do is send
us 2 of the following:
- Utility bill (Must indicate your new residence as the location of service)
- Bank account statement (Checking or savings)
- Credit card statement
- Confirmation of change of address from the United States Postal Service
- State issued ID (Driver's license or non-driver's ID)
**Online documents are not acceptable**
IMPORTANT NOTICE TO THE MEMBER
All documents must be issued within the past 3 months. To be considered for cancellation, your new residence must be more than 25 miles from any Lucille Roberts Health Clubs or its affiliates. The document(s) must contain your name, new address of residence (PO Box address will not be accepted) and date. Cancellations cannot be granted without the required document(s). Your monthly billing will only stop if the required documents are received. Do not send any original documents because they will not be returned.
Thank you for your cooperation. We hope to see you again in the future.
Please complete the form below and "Hit" the "Print" button on the bottom. Then print and fax the form along with the appropriate documents to (212) 734-9807 or mail to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.
If you have any questions, please call our Customer Service Representatives at 212-734-9717, Monday thru Friday 9-12 pm and 1-4 pm.
Please Note: All forms must be FULLY COMPLETE and mailed or faxed along with the required documents or we cannot complete your request. No email or other forms of response will be accepted.
Lucille Roberts Fitness Clubs
LR Customer Service Department