Certified Mail Cancellation Form

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Certified Mail Cancellation Form
Members Name: _______________________________
Any additional member(s) associated with Primary member (that will be canceling membership):
_________________________
__________________________
_________________________
__________________________
**Please print additional names clearly
Cancellation terms:
1.) Use this form for cancellation request sent by certified mail only.
2.) Cancellations are not accepted via fax or e-mail.
3.) You must keep your certified mail receipt as proof of sent cancellation.
4.) Request received within 10 days of next due date may get charged one more payment.
5.) Confirmation of cancelations will be e-mail delivery only.
6.) You must keep your e-mail confirmation until after your following months payment due
date as proof that no other payments should be withdrawn.
7.) Each member is separate in the system and must be canceled with separate email
confirmations.
8.) The confirmation will give the last dues date (if any) and the date of inactivation. You
must pay the last dues (if any) or that amount will be sent to our collections agency.
9.) Entry will not be allowed on or after the date the date of inactivation without a form of
payment listed on our price sheet.
Member’s Email address:____________________________________________
Member Signature: ______________________
Date: __________

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