2025 MMA Request for Hold on Membership

Mozhdeh Martial Arts - NZ

Request for membership to be placed on hold / Pause on payments
Athlete Information
Athlete’s name*

First NameLast Name
Birth date

DayMonthYear
Request type

Note: My membership can be placed on hold (pause on payments) for between 3 weeks and 12 weeks. I can request up to two holds per calendar year. 14 days notice is required to place my membership on hold. A small weekly $3 fee will apply during the hold to keep your spot reserved, and to cover admin costs.
I would like to:

Place my membership on hold for three weeks or longer (14 days notice required)
The date of my last class will be:
Date
The date when I expect to return is:
Date
Contact details (for parent/guardian if under 18)
Mobile Number*

eg 021Phone Number
E-mail
example@example.com
Name of parent / guardian if athlete is under 18

First NameLast Name
Confirmation

By clicking "submit form" below I authorise Mozhdeh Martial Arts to pause my direct debit for the duration of my hold request. My hold will be approved if I have provided at least 14 days notice. I can request up to two holds per calendar year and each hold can be of 3 weeks to 12 weeks duration. A small $3 weekly fee will apply during the hold to keep your spot reserved, and to cover admin costs.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

Mozhdeh Martial Arts - NZ