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
Submit
Should be Empty: