Update Your Membership - The Gap Health & Racquet Club.

Update Your Details

Name*
First Last
Current Email*
New Email*
Phone/Mobile*
Address*
Street Address City ZIP / Postal Code
Date of Birth*
Date Format: DD slash MM slash YYYY
Occupation
Update Your Emergency Contact
Name
Phone
Direct Debit Authority
This section forms part of your Updated Membership Agreement. Payments are transacted within 48 hours of completion of this online Membership Form.
I request the GHRC - ABN 86 056 961 409 to arrange for funds to be debited from my nominated credit card or bank account detailed below in accordance with this membership agreement.*
- Yes, I accept
I accept the GHRC Term & Conditions*
- Yes, I accept
Click to view Terms & Conditions
Update Your Payment Type
- Credit Card
- Bank Account
- No Change
Card Holders Name
BSB
Credit Card Number / Account Number
Expiry Date
Month*
Year*
CVV*