First Name *

Last Name *

Email *

What are you requesting to do? *

What membership do you have? *

Phone *

I acknowledge, If I am still within my membership minimum contract terms I will be charged a cancellation/downgrade fee of $200 or the remainder of my contract which ever is smaller. *

I understand.

I acknowledge, after this form has been submitted I will have 2 more weeks worth of payments be deducted before my membership closes/downgrades. (2 payments if I pay weekly, 1 if I pay fortnightly) *

I understand.