Variation Form

Matrix Boxing Gym Inc./Axis Gold Coast

Your Details

All fields are required.

First Name

Last Name

Your Email

Your Phone

Address

I want to...
Suspend my membershipCancel my membershipTransfer my membershipVary my payments

Suspend My Membership

2 weeks minimum, 1 month maximum (IN TOTAL each year * $5/fortnight suspension fee applies).

Begin suspension on (date):

End suspension on (date):

Reason:

Cancel My Membership

Cancelling within the minimum term will incur a cancellation fee of $300. 30 days written notice must be given.

Cancel my membership on (30 days notice required):

$300 early cancellation fee paid (if required)?

Reason:

Transfer My Membership

I am liable for all payments until transfer is completed. $50 Transfer Fee.

Transfer my membership to (name):

Transfer my membership on (date):

$50 transfer fee paid?

Reason:

Vary My Payments

Original amount ($):

New amount ($):

Vary my payments on (date):

Duration:

Reason:

Signatures

I have authority to alter this account (member, account holder or guardian). I must retain my copy of this variation. This form is not valid unless signed in the presence of an authorised staff member.

Today's Date

Signature of Member

Signature of Staff Member

Email a copy to (optional):