Membership Suspension Form Membership details Customer last name: Customer given names: Contact number: Customer ID: Membership type: Bronze Silver Gold Suspension details Please suspend my membership for the following dates (please note maximum suspension times apply): Suspension period 1: From date: To date: Reason for suspension: Suspension period 2: From date: To date: Reason for suspension: Suspension period 3: From date: To date: Reason for suspension: Customer signature: Office use only Processed by: Process date:
Membership Suspension Form Membership details Customer last name: Customer given names: Contact number: Customer ID: Membership type: Bronze Silver Gold Suspension details Please suspend my membership for the following dates (please note maximum suspension times apply): Suspension period 1: From date: To date: Reason for suspension: Suspension period 2: From date: To date: Reason for suspension: Suspension period 3: From date: To date: Reason for suspension: Customer signature: Office use only Processed by: Process date:
3_Latrobe_Leisure_Membership_Suspension_Form.docx