Membership Action Form 2026

Membership Action Form

Request to make a change to your Membership
Membership Tag Number:
If known
I,your name*, hereby authorise the following changes to be made to my membership and, if applicable, my existing contract with DebitSuccess, and I understand that changes to my direct debit payments will only be implemented prior to the next debit date if received at least 3 working days prior to that date.
Date:*

DayMonthYear
Date
Signature:*

Clear
Personal Details
Name:*

First NameLast Name
Email:*
example@example.com
Phone (mobile):*
New address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please tick if any of your personal details have changed from previously submitted information?

NameEmailPhoneAddress
Update bank details for Direct Debit
Financial Institution Name:
Account Name (name of account holder):
BSB:
Account number:
Updated credit card details for Direct Debit
For cyber safety reasons, credit card details cannot be submitted via an online form.

To update your direct debit credit card details, please submit your request in-person at Centre reception or email llc.admin@harvey.wa.gov.au
Request a Change to Your Membership Type

eg. upgrade/downgrade inclusions or change type of membership
Current Membership:

Aquatic onlyGym onlyGroup Fitness onlyFull access
Change my Membership to:

Full Access - 12 month upfrontFull Access - Direct Debit (ongoing)Fitness Only - 12 month upfrontFitness Only - Direct Debit (ongoing)Aquatic Only - 12 month upfrontAquatic Only - Direct Debit (ongoing)Family Aquatic - 12 month upfrontFamily Aquatic - Direct Debit (ongoing)
UPGRADES

For Direct Debit Memberships, you will be notified of the new fortnightly instalment amount once processed. For Upfront Memberships, you will be notified of the upgrade price once processed, to be paid at reception. Members are also required to complete a Variation Form for Direct Debit upgrades. Please contact a our Memberships Officer for more information.

DOWNGRADES

No monetary refund will be given and Direct Debit instalment amounts will not be reduced. Instead, bonus days equivalent to the difference in value will be added to the remaining time of the membership.

Please allow up to 14 business days for processing.
Should be Empty:

Membership Action Form

Personal Details

Update bank details for Direct Debit

Updated credit card details for Direct Debit

Request a Change to Your Membership Type

UPGRADES

DOWNGRADES