Membership Management Please complete and submit this form to place your fitness centre membership on hold. Membership Hold Today's date(Required)Email(Required) Name(Required) First Last Phone(Required)Start date for hold(Required)End date for hold(Required)Date that monthly payments will resume(Required)Are you placing your membership on hold for a medical reason?(Required) Yes No If yes, is a note from a medical professional attached?(Required) Yes No I have been informed and am aware of the following conditions:(Required) 1. An administration fee of $10 per month is required for the duration of the membership hold. 2. My membership can be placed on hold for an unlimited duration of time. 3. When I return to Heritage Community Fitness & Rehabilitation Centre after my hold period, I must sign the membership hold conclusion portion of this form to resume my membership. 4. Annual Memberships: Upon my return, the expiry date of my membership will be extended to match the exact amount of time for which my membership was placed on hold. 5. Monthly Memberships: My monthly installments will pause during the hold period and will resume upon my return to Heritage Community Fitness & Rehabilitation Centre. Monthly installments will automatically resume on the date indicated in the “Date monthly payments will resume” field above. Payment Method(Required)If you do not wish to use the credit card we have on file or if we don’t have your credit card on file, please select “New credit card” and proceed to the payment portal through the link below. Credit card on file New credit card Membership Hold Use this payment option if you do not wish to use the credit card we have on file for this transaction or if we don’t have your credit card on file. Continue to payment portal