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Membership Suspension Application Form - Special Conditions

Club *

NSW - Warners Bay 24/7

First Name *

Last Name *

Billing Reference *

Email *

Mobile *

Membership Payment Method *

Direct Debit Paid in Full

Suspend Membership From *

Duration of Suspension *

Reason for Suspension *

Suspension fee *

$5 per week No Charge

Staff Name *

*

I agree to terms and conditions

Membership Suspension Terms and Conditions:

The Centre must be notified in writing with reasonable notice (at least 3 days) prior to the date of suspension. I, the undersigned, request to suspend my membership for the timeframe above as per the terms of my Direct Debit Request (DDR) and Contract. In the event of special circumstance you may be allowed extended suspension periods which must be first reviewed and approved in writing. I also understand that any time spent on suspension will be added onto the minimum term of the Agreement. I understand that if my account is in default I must arrange to pay all monies owing before a suspension can be processed. This form is only a membership suspension application form and if your suspension is outside your terms and conditions your membership is not considered suspended until you receive email confirmation from Genesis or Debitsuccess.

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