Edith Cowan University
Sport and Fitness Centre
Application for Membership Suspension
* Indicates a mandatory field
Full Name*
*
Membership Number
Email*
*
*
Phone*
*
Mobile Phone
Membership Type:
Health and Fitness
ShapeHer
Membership Payment Type:
Fortnightly Bank Account
Fixed Term / Lump Sum
Fortnightly Credit Card
ECU Staff Payroll
Did you sign up at:
Joondalup
Mount Lawley
Suspension Details
Reason for suspension:
Non-Medical
Cost $5 per fortnight
Maximum duration of 6 months per year
Back-dated suspensions not accepted
Payment required upon application
Medical
No charge
Medical certificate required to
ecusports@ecu.edu.au
Start and end date of no more than 6 months
Medical suspension can be backdated within 3 months of issue
ECU Staff Member
Work related supply supervisor/manger confirmation to
ecusports@ecu.edu.au
Cannot be backdated
Suspension start from:
<
May 2024
>
Su
Mo
Tu
We
Th
Fr
Sa
28
29
30
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Length of suspension:
2 Weeks
4 Weeks
6 Weeks
8 Weeks
10 Weeks
12 Weeks
14 Weeks
16 Weeks
18 Weeks
20 Weeks
22 Weeks
24 Weeks
End date:
23/05/2024 Thu
Amount:
$5.00
I will pay the above amount by:
Online Credit Card Payment
Security Code* :
Terms and Conditions
I understand that my membership, and direct debit payments, will automatically be reactivated at the end of the suspension. Please note, bank and credit card debits, suspending your membership will change the date your account is debited. For example: a member was typically debited on the 2nd and 16th of the month. If they suspended from the 4th to the 10th their new debit date is now the 23rd of the month and then fortnightly going forward. The suspension has "pushed back" their debit date by the number of days of suspension. Please allow 48 hours for processing.
I have read and understood these terms and conditions
*
Please enter any additional instructions or comments: