HRCC - Membership Suspension Form

Membership Suspension Request Form
Terms and Conditions of Membership Suspension

Suspension requests must be submitted via the relevant form before your intended absence. Suspension requests cannot be back-dated.

You must specify a return date - “until further notice” is not permitted. Your membership will automatically resume on the nominated return date without additional notice.

Suspensions are free of charge within the following limits:
- 3-month membership: 2 weeks minimum, 1 month maximum
- 6-month membership: 2 weeks minimum, 2 months maximum
- 12-month membership: 2 weeks minimum, 3 months maximum
With a valid medical certificate, suspensions may be extended up to 150 days. Please allow 7 days’ notice for all suspension requests. Memberships cannot be cancelled while suspended.
Member's Details:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

DayMonthYear
Date
Email
example@example.com
Start date of suspension

DayMonthYear
Date
Membership recommencement date

DayMonthYear
Date
Please specify the reason for your suspension request
Additional information to support your request
By signing and submitting this form you agree to the terms and conditions of membership suspension
Privacy Collection Notice: The Shire of Harvey collects personal information to respond to enquiries and deliver services. Information is managed in accordance with applicable legislation and may be disclosed where authorised or required by law. For further information, visit the Collection Notices page .
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Membership Suspension Request Form

Member's Details: