Membership Suspension Request

Membership suspension

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

"*" indicates required fields

Name

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

Name*

First Last

Email*

example@example.com

Mobile*

0400 000 000

Your Membership Type*

Select an Active Merri-Bek Venue*

Suspend Membership from*

Suspend Membership to*

Reason for Suspension*

If applicable, please attach proof of medical certificate

Accepted file types: jpg, png, pdf, Max. file size: 4 MB.

Please remove any sensitive information from your attachment (eg. Medicare card details)