Membership Suspension Request

Please complete the form below to make a request to temporally suspend your membership.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

example@example.com

Mobile*

0400 000 000

Debit Success Reference Number

Your ref. number can be found in your welcome email

Your Membership Type

Suspend Membership from*

Suspend Membership to*

Reason for Suspension*

If applicable, please attach proof of medical certificate

Accepted file types: jpg, png, pdf, Max. file size: 4 MB.

Please remove any sensitive information from your attachment (eg. Medicare card details)

I agree to Terms and Conditions*

Source

Venue Name