DEPARTURE REQUEST FORM

The below departure request form is applicable for Mosman Swim Centre Memberships only. Please note if you are an Ezyswim member, please visit www.ezyswim.com.au to complete applicable departure request form.

Responsible Person:

First Name (required):

Surname (required):

Email (required):

Mobile Phone (required):

Member Number (if known):

Member Details:

Member 1:

First Name:

Surname:

DOB:

Member 2:

First Name:

Surname:

DOB:

Member 3:

First Name:

Surname:

DOB:

Membership Type:

Membership Type: (required)

Reason for Departure:

Reason for leaving - comments:

Feedback:

We appreciate you taking the time to give us some feedback.

What areas did you enjoy?

What areas need improvement?

Would you recommend us to others?

Would you like to be contacted regarding this departure?

Terms and conditions:

By selecting the below box, you agree to the following:

  1. You agree that you would like your membership cancelled as per the terms and conditions of the enrolment.

  2. You understand and agree that a membership may be cancelled for the following calendar month by giving notice by the 25th day of the current month. I acknowledge that once I do so, Ezyswim cannot guarantee that the same membership, fees and benefits will be available when re-joining.

  3. You agree that you are responsible for individually departing all family members from your membership and if you are departing multiple memberships, that you state on the form.

  4. Departure requests received after the 25th day of the current month will not take effect until the month after. Please clearly read the example below:

    Example: depart on the 26th March or later you will still be charged for and able to swim until the end of April. Your departure will be finalised on 30th April and you will not be charged for May. However if you depart on 25th March, you will not be charged for April.

  5. I understand that if I do not receive a departure reference number, my departure has not processed and I must contact Ezyswim immediately on 1300 11 7946 or complete the online departure form again.

Disclaimer – If you have not received a Departure Reference Number, your Departure has not been processed. Please resubmit if this is the case.

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