BL Suspension Application Request Form

Cancellation Application Request Form
Select your centre *
Membership/Program Type
Name *

First Name Last Name
Email *
example@example.com
Mobile *
0400 000 000
Reason for wishing to leave 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.
Should be Empty:

Cancellation Application Request Form