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 months - 15th October to 14th November, next full direct debit collection 15th November 2 months - 15th October to 14th December, next full direct debit collection 15th December 3 months - 15th October to 14th January 2021, next full direct debit collection 15th January 2021 4 months - 15th October to 14th February 2021, next full direct debit collection 15th February 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
LifeLEISURE is a Charitable Trust, which provides leisure and recreation facilities for the community. We usually charge £5 per month to freeze a membership, however during this time we are currently waiving that fee as a goodwill gesture. However you are able to donate £5 per month during your freeze at lifeLEISURE. *

Yes I would like to donate £5 per month during my freeze. No I don't want to donate.
As we have now passed the cutoff date for amending direct debit collections, we are unable to stop the pro rated collection scheduled for the 15th September 2020 and so this payment will be collected from your account.
I sign to confirm I would like to freeze my membership. *

Clear
I sign to confirm I would like to freeze my membership and donate £5 per month to LifeLEISURE. *

Clear
Date *

Day Month Year
Date
Should be Empty: