Suspension Form

SUSPENSION FORM

Please fill in the form below to pause your in-house gym membership with us. Our team will be in contact with you shortly (within the next business day) to confirm your suspension has been processed.

Before we continue, a friendly reminder:

Two week minimum suspension and eight week maximum suspension each year, unless you can provide a medical certificate.

There is a one-off admin fee of $20 for each suspension. Suspensions cannot be backdated.

Pro-rata suspensions are not allowed (i.e. outside of the normal fortnightly billing cycle)
Name

First NameLast Name
Email
example@example.com
Gender
Mobile Number
Reason for suspension

MedicalInjuryTravelOther
If Other, please explain
If you have selected medical or injury please attach a verified doctor's note below.

Cancelof
Have you paused your membership at any other time this year?

YesNoI'm not sure
If yes, how long total have you paused?
Please START my pause from this date:

MonthDayYear
Date
Please END my pause on this date:

MonthDayYear
Date
By submitting this form, you agree to the following:

1. A one-off $20 holding fee will be charged to my account to keep my membership on hold.

2. I will make contact to The Cobalt Club if my pause duration needs to be altered in any way.

3. I accept that my pause may be denied due to passing my maximum use of 8 weeks per annual.
Should be Empty: