BL Cancellation Application Request Form

Cancellation Request Form
Select your centre*
Membership Type
Select your membership type

GOswimHealth & WellnessAquaticGymnasticsFull Access
Name*

First NameLast Name
Email*
example@example.com
Mobile*
0400 000 000
Reason for wishing to leave facility*
If joining a different gym, please specify which one you are planning to join
If applicable, attach proof of medical certificate

Browse Files

Cancelof
I agree to Terms and Conditions*

I, the undersigned do hereby request that my direct debit membership be cancelled. I understand that a notice period is required for all cancellation requests (usually 30 days), unless specified otherwise on my contract. I understand that my membership cannot be cancelled while my account has overdue payments and I must pay all monies owing before cancellation can take effect.
Should be Empty:

Cancellation Request Form