Membership Suspension Form

Please note suspensions are unable to be back dated

In this situation make up classes would need to be taken
Your Name*

First Name Surname
Contact Number*
Email*
example@example.com
Reason for Membership Suspension*
Will you be travelling internationally?*
If travelling internationally, what countries will you be visiting?
How many memberships are you wanting to suspend?*
Student's Name (If not the person completing this form)

First Name Last Name
Membership Type*

Paysmart (Weekly via Direct Debit)Paysmart (Fortnightly via DIrect Debit)3 Months Upfront6 Months Upfront12 Months UpfrontUnsure
Membership Suspension Start Date*

DayMonth Year
This is the first day you are not able to attend classes. Suspensions cannot be backdated. Please enter date in DD/MM/YYYY format eg 01/12/1999
Membership Suspension End Date*

DayMonth Year
This is the final date you will not be able to attend classes. Please enter date in DD/MM/YYYY format eg 01/12/1999: NOTE: Suspensions must be requested for a minimum of 2 week blocks as per the Membership Suspension conditions.
Number of Weeks*
Please upload any supporting document here

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(Medical certificate, Travel Document, etc)
Cancelof
Conditions of Membership Suspensions:

Please read carefully as charges may apply
- Membership suspension requests are permitted only for student's who have their account fees upto date prior to the suspension start date.
- Memberships can be suspended with a minimum of 2 weeks at a time and a maximum of 4 weeks per calendar year at no charge.
- Memberships suspended for periods longer than 4 weeks in a 12 month period are charged at $7.50 per week for every week after the 4th. This fee is to reserve a place in classes for every week after the permitted 4 week allowance and is payable prior to the suspension start date.
- Memberships suspended for medical reasons will not count towards the permittable 4 weeks suspension if a doctor's certificate that covers all requested dates of suspension.
- All medical suspensions are free of charge upon presentation of a valid medical certificate that covers all requested dates of suspension.
- Paysmart Memberships will have debits paused for the total of weeks suspended, minus any suspension fees applicable.
- Paysmart Members are required to submit a suspension request a minimum of 7 days prior to the suspension beginning date to avoid any payments being debited during the requested suspension period.
- Upfront Memberships will be extended based on the number of weeks your suspension is requested and an invoice for any applicable suspension fees will be issued and require payment prior to the suspension.
- Membership suspensions cannot be back dated.
Member's Signature

Clear
Date Signed

DayMonth Year
Date

OFFICE USE ONLY
Processed By Staff Member

First Name Last Name
DIRECT DEBIT: Vary payment suspension effective date

DayMonth Year
DIRECT DEBIT: Vary payment resume date

DayMonth Year
UPFRONT MEMBERSHIP: Next fee cycle original due date

DayMonth Year
UPFRONT MEMBERSHIP: Next fee cycle new due date

DayMonth Year
UPFRONT MEMBERSHIP:

Update new due date in QB - YYYY/MM/DD
UPDATE NOTES IN QB:

DD & UF: Suspension datesDD & UF: Original due dateDD & UF: QB: New due dateDD & UF: Number of weeks suspendedDD & UF: Suspension tally
SUSPENSION CHARGES:

DD: Processed via PaysmartUF: Invoice created and emailed to MemberDo not apply to this suspension
Date Processed

DayMonth Year
Approver Signature

Clear
Should be Empty:

Please note suspensions are unable to be back dated

Conditions of Membership Suspensions: