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FIRST NAME:(Required)

SURNAME:(Required)

EMAIL:(Required)

MOBILE NUMBER:(Required)

CLUB:(Required)

WHAT DO YOU NEED ASSISTANCE WITH?(Required)

WHAT DO YOU NEED ASSISTANCE WITH? - ADMIN(Required)

REASON FOR PAUSE REQUEST(Required)

VARIATION TYPE

REASON FOR CANCELLATION / REVOKE MY CANCEL(Required)

PLEASE SPECIFY WHY YOU ARE LOOKING TO CANCEL(Required)

SELECT MEMBERSHIP TYPE FOR UPGRADE or DOWNGRADE (BIBRA LAKE)(Required)

SELECT MEMBERSHIP TYPE FOR UPGRADE or DOWNGRADE (ADMIN)(Required)

ARE YOU A STUDENT OR AGED 60+

MEMBERSHIP PRICE (PER WEEK/PW) (ADMIN)

SELECT MEMBERSHIP TYPE FOR UPGRADE or DOWNGRADE (CANNING VALE)(Required)

MEMBERSHIP PRICE (PER WEEK/PW) (CANNING VALE)

SELECT MEMBERSHIP TYPE FOR UPGRADE or DOWNGRADE (COCKBURN)(Required)

MEMBERSHIP PRICE (PER WEEK/PW) (COCKBURN)

SELECT MEMBERSHIP TYPE FOR UPGRADE or DOWNGRADE (JANDAKOT)(Required)

MEMBERSHIP PRICE (PER WEEK/PW) (JANDAKOT)

MEMBERSHIP PRICE (PER WEEK/PW) (BIBRA LAKE)(Required)

MEMBERSHIP PRICE (PER WEEK/PW)

MEMBERSHIP MINIMUM TERM

WHAT TIME DO YOU PREFER(Required)

PAUSE START DATE:(Required)

Please note all pauses are for a minimum period of 2 weeks

PAUSE END DATE:(Required)

Please note all pauses are for a maximum period of 12 weeks

PLEASE GIVE US MORE DETAIL:

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