La Roca Membership amendment form

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This form is for La Roca members who wish to suspend, pause or terminate their membership.

- You must submit this form at least 2 business days prior to the commencement date of your suspension.
- Memberships can not be suspended retrospectively.
- All amendment requests are pending approval from La Roca staff.
- Amendments are only actioned Monday to Friday during business hours.
- You will receive a confirmation email once your membership amendment has been actioned.

For any urgent suspensions please call us or see us in person.

Email *

Full name *

Phone number *

Type of amendment *

Pause my upfront membership

Pause weekly direct debit membership

Terminate my weekly direct debit membership

Other:

Stop my membership on this day (dd/mm/yyyy) *

YYYY

Resume my membership on this day (dd/mm/yyyy). Leave this blank if you are looking to pause your membership indefinitely or requesting to terminate your membership.

YYYY

Reason for amendment *

Travel

Study

Injury or illness

Other:

A copy of your responses will be emailed to the address you provided.

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