Member Area Deferred Fee Request * Preferred Name Given Name Surname Please describe the reason you are requesting to have your Membership Fee deferred. Example: I had an unexpected dental bill and do not have sufficient funds, in my account, to cover the direct debit, until my next pay day"*Please describe the reason you are requesting to have your Membership Fee deferred. Example: I had an unexpected dental bill and do not have sufficient funds, in my account, to cover the direct debit, until my next pay day"Contribution*Please select the amount that you are able to contribute to your membership FeePlease SelectI cannot contribute to my Regular Fee$10.00$20.00$30.00$40.00Date of deferred Regular Fee.*Date of deferred Regular Fee. Day Month Year Please select the date by which you will pay your Regular Fee. (maximum 12 weeks from the date your fee was due to be charged)*Please select the date by which you will pay your Regular Fee. (maximum 12 weeks from the date your fee was due to be charged) Day Month Year I confirm*I confirm The Deferred Fee Request is being made at least 7 days before the fee was to be charged Δ
