Membership Suspension Request
Member Name
*
First Name
Last Name
Email
*
example@example.com
Date suspension due to Commence (72 hours notice)
*
-
Day
-
Month
Year
Date
Date suspension due to End (Club access available following day)
*
-
Day
-
Month
Year
Date
How many weeks would you like to suspend (Minimum 1 week blocks)
*
1
2
3
4
Other
Suspension reason?
Please let us know if there is an extended reason for the suspension, or if it is for a holiday/break/injury?
I understand that after my free suspension period I will be responsible for a processing fee during suspension and that billing will commence as usual upon the suspension expiring.
*
Yes
No
I understand that my account must be in good standing to qualify for a suspension.
*
Yes
No
I understand that if I wish to resume my gym activities early before expiry of the suspension, I can notify In Balance Fitness and my account can be reactivated.
*
Yes
No
File attached
Browse Files
Medical Certificate if required
Cancel
of
Member Signature
*
Submit
Should be Empty: