Edith Cowan University
Sport and Fitness Centre
Application for Membership Suspension

* Indicates a mandatory field

Full Name*  
Email*     
Phone*  
Membership Payment Type:

Membership Location:
Suspension Details
Reason for suspension:


Suspension start from:
<March 2024>
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Length of suspension:
End date: 14/04/2024 Sun
Amount: $5.00
I will pay the above amount by:

Security Code* :
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Terms and Conditions


 
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