Replacement Card - $30 Administration Fee Required

First Name *

Last Name *

Member Number

LOCATION *

Sex *

Mailing Address (Replacement Card will be sent here) *

State *

Post Code *

Email Address *

Mobile Phone Number *

Please attach a Photo for your Membership Card (Optional)

You must provide two recent identical colour photographs of yourself. With a maximum file size of 256KB.

Warning: Unacceptable photos will delay the processing of your application.

If you do not attach a new picture we will use what is already on our system. Attachment must be a recent colour photograph of your face with a maximum file size of 2MB. Any photo that can be taken automatically by an inbuilt laptop/phone camera or a web camera will be accepted. Your photo must be a clear, unmodified photo of your face.

Please Attach Photo 🛈

Please complete Payment Details for the $30 (GST Inclusive) Administration Fee

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

All payments will be taken by Centrality PTY LTD Reservoir (ACN: 114163585)

Please note that all 247XERCISE payments will be processed by 247Xercise PTY LTD (ACN: 143 422 486), which will be shown on your credit card statement.

SPECIAL REQUIREMENTS & COMMENTS:

Please click on the submit button at the bottom of the screen. Your application will be processed when you submit this form and a receipt and membership card will be sent to your mailing address.