Health Fund Receipt Request

Personal Details

Membership Type*

Name*

First Name

Last Name

Date of Birth*

For identity verification

Phone*

Email Address*

Confirmation of your request will be sent to this email address

Please note, Health Fund Receipts cannot be provided for future payments.

Start date*

End date*

Preferred Method of Delivery:*

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Click here to view Macquarie University Sport and Aquatic Centre's Privacy Policy.

Terms and Conditions Acknowledgement*

I acknowledge that I have read and agree to Macquarie University Sport and Aquatic Centre's Terms and Conditions.

I acknowledge that I have read and agree to Macquarie University Sport and Aquatic Centre's Privacy Policy.

Signature*

Use your mouse or finger to draw your signature above

Date/Time*