Life Leisure Membership Freeze Request

Life Leisure Membership Freeze Request
Member Number *
Member's Name *

First Name Last Name
Email *
example@example.com
How long do you want to freeze for? *

1 Month - 15th May to 14th June 2021, next Direct Debit collection 15th June 2021 2 Months - 15th May to 14th July 2021, next Direct Debit collection 15th July 2021 3 Months - 15th May to 14th August 2021, next Direct Debit collection 15th August 2021
Reason for requesting a freeze? *

Don't feel comfortable going to Leisure Centres at this time I'm shielding or in the vulnerable category Financial Reasons Due to the refurbishment work at Romiley
I sign to confirm I would like to freeze my membership. *

Clear
Date *

Day Month Year
Date
Should be Empty: