Membership Freeze Request Form

First Name Required

Last Name Required

UofG Sport Membership Number (or Staff No.) Required

Email Address Required

Please enter a valid email address.

Phone Number

Membership Payment Type Required

Please select Direct Debit Staff Payroll Mandate

Date to stop payments
Date entered must be 15th of the month e.g. 15/09/2020

(dd/mm/yyyy)

Date to restart payments
Date entered must be 15th of the month e.g. 15/11/2020

(dd/mm/yyyy)

Date to stop payments
Date entered must be 1st of the month e.g. 01/09/2020

(dd/mm/yyyy)

Date to restart payments
Date entered must be 1st of the month e.g. 01/11/2020

(dd/mm/yyyy)

Reason for freeze