Cancellation Application Request Form
Select your centre
*
Ascot Vale Leisure Centre
Keilor East Leisure Centre
Membership/Program Type
Aquatic/Gym Membership
Swim School Membership
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile
*
0400 000 000
Reason for wishing to leave facility
*
Lack of Motivation
Not getting results
Schedule (time, work commitments)
Financially unable to continue membership
Dissatisfied with the facility
Medical/Illness - short term
Permanently unable to participate in regular exercise, long term illness or disability
Moving to different location
Joined another fitness facility
I agree to Terms and Conditions
*
I, the undersigned do hereby request that my direct debit membership be cancelled. I understand that a notice period is required for all cancellation requests (14 days), unless specified otherwise on my contract. I understand that my membership cannot be cancelled while my account has overdue payments and I must pay all monies owing before cancellation can take effect.
Submit Request
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