Cancel your health club or aquatic membership

First Name:

Last Name:

Contact Number:

Email Address:

Reason for cancelling:

Cancellation Date

Please specify a date you would like your membership cancelled from (It must be at least 28 days from today)

Please check the boxes to acknowledge all of the following:

From:

My cancellation date is at least 28 days from today's date

I acknowledge that if I am within a 6 month minimum term membership, I will be charged an early exit fee of $49

I understand that my membership type/rate may not be available if I wish to join Cockburn ARC in the future

A suspension cannot be imposed during the 28 day notice period. If you are currently suspended, your membership will be reactivated and the pro-rata will be added to your next direct debit

I understand that any suspension time taken does not form part of a minimum membership term

I understand all outstanding payments must be paid

I acknowledge I have authority to submit this form.