Name *

First Name

Last Name

Date-of-Birth *

MM

DD

YYYY

How long have you been a member? *

1 - 4 months

4 - 8 months

8 - 12 months

1 - 2 years

2 - 3 years

3 or more years

Why did you decide to cancel your membership? *

Not using enough

Facility does not offer what I need

Moving away from the area

Too expensive

Other

On a scale of 1 to 5, with 5 being the highest, please rate the following: Cleanliness *

1

2

3

4

5

On a scale of 1 to 5, with 5 being the highest, please rate the following: Route variety and/or quality *

1

2

3

4

5

On a scale of 1 to 5, with 5 being the highest, please rate the following: Knowledgeable Staff *

1

2

3

4

5

On a scale of 1 to 5, with 5 being the highest, please rate the following: Quality of fitness equipment *

1

2

3

4

5

Would you recommend NH Climbing & Fitness to a friend? *

Yes

No