Health club or aquatic medical membership suspension

All fields are required except where indicated.

First Name:

Surname:

Email address:

Contact number:

Please acknowledge:

I acknowledge that my suspension request may take up to five (5) business days’ notice to be processed.

I acknowledge that suspensions must be for a minimum of seven (7) days.

I understand that my membership will become active after the specified suspension end date.

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

I understand that membership payments will not be taken for the days I am suspended, a prorata amount for the fortnight leaving and returning will be deducted.

I wish to suspend my membership due to medical reasons for the following period:

From date:

To date:

Upload medical evidence:

I understand that if I wish to return earlier than the dates specified on my certificate, I must obtain a medical clearance.