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STUDENT NAME /S
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PARENT NAME (If Applicable)
CONTACT EMAIL
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PHONE
CLASS LOCATION
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BLACKBUTT
CHINCHILLA
DALBY
GYMPIE
KINGAROY
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I WISH TO (Please select one):
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DEFER MY PAYMENTS (Please provide dates in the text field below)
CANCEL / STOP PAYMENTS FROM MY ACCOUNT
PLACE ON HOLD – UNTIL FURTHER NOTICE (NO FEE APPLIES)
TRANSFER MY MEMBERSHIP TO ANOTHER PERSON
REACTIVATE MY MEMBERSHIP
REASON:
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INJURY
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BEST CONTACT METHOD:
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TERMS & CONDITIONS
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BY CHECKING THIS BOX, I AM AWARE AND ACCEPT THAT PAYMENTS MAY TAKE UP TO 14 DAYS TO CANCEL / STOP.
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