Membership Cancellation Request

Membership cancellation

Please complete the form below to make a request to cancel your membership.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Select a MOVE Venue*

Select a Mornington Peninsula Shire Active Venue*

Select a District Council of Loxton Waikerie Venue*

Select a Loddon Shire Council Venue*

Select a Pyrenees Shire Council Venue*

Select a Strathbogie Shire Council Venue*

Select a Toowoomba Regional Council Venue*

Select an Active Merri-Bek Venue*

Name*

First Last

Email*

example@example.com

Mobile*

0400 000 000

Your Membership Type

Reason for Cancellation*

This field is hidden when viewing the form

URL

This field is hidden when viewing the form

Venue Name