VIC OPT OUT MEMBERSHIPS

Membership Suspension Request
Select your centre location *
Name *

First Name Last Name
Email *
example@example.com
Mobile *
0400 000 000
Debit Success Reference Number (optional)
Membership Payment Method

Direct Debit Paid in Full
Membership Reactivation Acknowledgement Terms and Conditions: *

I, the undersigned, request to suspend my membership for the time frame above as per the terms of my Direct Debit Request (DDR) and Contract. I understand that I can suspend my membership at $5.00 per week for a maximum of 4 weeks. I understand that if my account is in overdue status, I must arrange to pay all monies owing before a suspension can be processed. I consider my membership to be suspended for the dates i have requested unless i am notified otherwise from the customer care team via email.
Should be Empty:

Membership Suspension Request