Request to Change Membership Status

Please complete this form to set your membership to Inactive Status or Cancel your membership.

INACTIVE STATUS:

Members with an Inactive status will remain HCA members however they may not conduct business or act as a member under their original HCA professional member titles (or any variation thereof) nor are they permitted to use HCA invoices or act as a professional member of HCA from the date your Inactive status goes into effect.

Your member since date will remain “as is” which will keep you qualified for client reimbursements on or before the date of INACTIVE status, and your liability insurance will remain in effect for retroactive activities from date of inception.

TERMINATED STATUS:

If you would like to cancel your membership, please select this option. By selecting this option, you are opting to stop your membership and autorenew payment once your paid year is complete.

Name

First NameLast Name

Email (this must be the email used for your membership for the payments to be cancelled)

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Membership Number

How would you like to change the status of your membership?

Reason for Membership Status Change

INACTIVE STATUS: I understand that although I remain a member, my liability insurance will be limited to claims resulting from retroactive professional activities. My coverage will resume in full effect once I have returned to full professional status.

Cancelling Members: As per my signed agreement, I acknowledge and agree to remove my certificate and "Approved Member" seal and professional title from my website and any correspondence once my membership status request has been changed. I will not represent myself as an HCA member. I understand that I will no longer be permitted to use the invoices or indicate in any way that I am a registered member.

Cancelling Members: I agree that I will no longer provide receipts to my customers with my member number and title on them and I understand that I must be a member of an association to allow my clients to submit claims. I understand that HCA will not verify any claims made to an insurance company for client reimbursement or wellness wallets once your membership has officially expired.

Cancelling Members: I understand that by cancelling my membership, I am opting to leave the group, and therefore, my liability insurance will no longer be valid from the date that my membership ends. I understand that my coverage covers me for all claims made against me since inception of my policy and with full knowledge of this, I am surrendering the membership and policy.

By filling out and submitting this form, I am herby giving my notice and requesting to change or terminate my membership. I am responsible for any charges that are incurred within this 48 hour window as per my signed agreement and the Terms and Conditions when signing up.

Signature

Submitting this form will automically stop all future membership payments within 48 hours. If you are cancelling your membership well in advance of your expiry date, your membership, access to the site and insurances will remain active until you have officially expired.

If you are setting your membership to status to Inactive, please ensure you return to the membership area to set up your payment.