Membership Suspension Request
CLUB
*
Please Select
ALTONA MEADOWS
WERRIBEE
Staff Name
*
Online
Stephanie
Jason
Julie
Ante
Maddison
Hollie
Serena
Evie
Renae
Eva
Emma
Other
Member Name
*
First Name
Last Name
Email
*
example@example.com
Date suspension due to Commence (must have 48 business hours notice)
*
-
Day
-
Month
Year
Date
Date suspension due to End (Club access available following day)
*
-
Day
-
Month
Year
Date
How many weeks would you like to suspend (Minimum 1 week - weekly blocks only)
*
1
2
3
4
additional weeks
Why would you like to suspend?
*
Please explain
Medical Note Provided
*
Yes
No
I understand that after my free suspension period I will be responsible for a processing fee during suspension and that billing will commence as usual upon the suspension expiring.
*
Yes
No
I understand that my account must be in good standing to qualify for a suspension
*
Yes
No
I understand that if I wish to resume my gym activities early before expiry of the suspension, I must notify the In Balance Fitness Staff to my account can be reactivated.
*
Yes
No
File attached (such as medical proof)
Browse Files
Cancel
of
Member Signature
*
Submit
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