Membership Variation Form

"*" indicates required fields

Member Details

Member Full Name:*

Please provide your Full Name as stated on your membership.

Phone Number:*

Email Address:*

Residential Address:*

Street Address State / Province / Region ZIP / Postal Code

Birth Date:*

Emergency Contact Name*

Emergency Contact Number:*

Please Confirm Your New Membership Type

To finalise your change of membership type, kindly check the box of which membership you would like to switch to. Please keep in mind this form does not change your membership term only the type & rate. All previous terms & conditions on the original agreement apply.

New membership Type*

Full Access Membership

Off Peak Membership

FIFO Membership

Other

Your membership variation & new rate will be confirmed via email including when the change will take pace (next payment date).

Acknowlegement of Variation.

Membership Holders Signature*

By signing this form, I hereby acknowledge my agreement to all the terms and conditions, as well as the assumed risk and liability outlined above.

Membership Variation Form