Member's Name
*
First Name
Last Name
Mobile
*
Please enter a valid phone number.
Email
*
example@example.com
Home Club
*
Please Select
Thornleigh, NSW
Alexandria, NSW
Chatswood, NSW
Select the Monday from which you want your freeze to start?
*
-
Day
-
Month
Year
If you select a Monday during a non billing week, we will set to the following Monday.
Length of Freeze (in weeks)
*
Please Select
4
6
8
10
12
By signing this form, you acknowledge to allow 72 hours (3 days) for your freeze request to be actioned. You acknowledge that you may be charged if requested within 72 hours of your next scheduled direct debit payment. In this instance, your freeze will be backdated and your account will be prorated. You also agree that your membership fees are up to date and any overdue arrears will need to be processed prior to the approval of your freeze request.
*
Yes
Signature
Any additional information you'd like to share about your freeze?
Submit
Should be Empty: