Sydney Olympic Park Sports Centre

Zubin Weightlifting Club PTY LTD ABN: 84 602 619 509 Sydney Olympic Park Sports Centre

Zubin Weightlifting Club Direct Debit Form

Name as it appears on drivers licence: ______

Drivers licence number: ______State:______

Option 1. Credit/debit Card number:______

Expiry date: ______Name on card: ______CVC/CVV: ______

Option 2. BSB: ______Acc: ______Account name: ______

Home address:______

Phone number:______Email address: ______

Type of membership: Casual $20/session Full $150/month

Online coaching $60/month one-on-one coaching $80/hour

Joining/Administration Fee: $______payable with the first direct debit

1. All freezing or cancelations requires 30 days’ notice in writing including the member’s full name and “to” date submitted to [email protected]

2. The direct debits will continue as per the agreement until further notice by client in writing to [email protected] with at least 30 days’ notice.

3. All direct debits are monthly, if a direct debit defaults there is a $10 default fee payable to Zubin Weightlifting Club Pty Ltd plus a $6.60 surcharge payable to the direct debiting company both of which will be charged in the next scheduled direct debit date which will also backdate the original defaulted direct debit as well as any other outstanding fees and charges

4. All standard direct debit transactions carry a $0.55 fee and merchant fees are 1.65% for Visa and MasterCard and 4.2% for American Express and Diners Club.

5. I acknowledge that I have been given the option of choosing a membership based on either periodic billing (i.e. direct debit) or pre-payment. I have chosen to pay my membership by periodic billing (i.e. direct debit)/pre-pay my entire membership fee (cross out whichever does not apply). 6. I acknowledge that unless I provide written notice of termination of my membership prior to the end of the minimum period of my Periodic Billing Membership Contract, my membership fees will continue to be deducted until 30 days after I provide written notice of termination to the Fitness Centre. I understand that the Fitness Centre must respond to its receipt of a written termination notice within 7 days. Name: ______

Date: ______Sign:______