BNI NW Florida Member Status Report
This form provides notification to the Regional Office of roster changes. Please use one form per membership change.
Date
*
-
Month
-
Day
Year
Date
Chapter Name
*
Report Submitted By
*
Please Select
Secretary/Treasurer
Vice President
Membership Committee
Chapter Director
Regional Office
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
There are three ways a member is to be removed from the chapter membership roster.
1. The member resigns their membership or chooses not to renew.2. The Membership Committee terminates the membership.*3. The Membership Committee declines the member's renewal.**Required Director Approval
Member's Name
*
First Name
Last Name
1. Member RESIGNED for the following reason: This allows the Regional Office to track the reason members have left the organization.
*
Economic Distress
Changed Jobs
Did Not Renew
Left Company
MSP Not Completed
No Reason Given
Lack of Referrals
Not right fit with Company
Personal Reasons
Relocated
Scheduling Conflicts
Takes too much time
Transfer BNI Chapters
2. Membership Committee TERMINATED the membership for the following reason:
*
Attendance
Code of Ethics
Participation
Relocating
3. Membership Committee DENIED RENEWAL for the following reason(s):
Lack of Participation
Lack of Referral Given
Lack of Visitors Invited
Other (provided additional details below)
Effective Date of Member's Drop:
*
-
Month
-
Day
Year
Enter the date of the member's last meeting OR date in which the chapter terminated the membership. If the member submitted a resignation letter please copy/paste the notice in the Additional Information box below.
Additional Information
Was the member in good standing with the chapter upon their departure?
*
Yes
No
Submit
Should be Empty: