Membership Resignation Request Form

Membership Resignation Request Form
#104-2476 Westlake Rd, West Kelowna, BC V1Z 2V2 (250) 769-5117
Name of Member*
Today's Date*

MonthDayYear
Date
Membership Number
Current Address*
Phone Number*
Email*
example@example.com
I,
Full Name*

First NameLast Name
wish to resign (discontinue) my membership with Aesthetic Nation. I am aware that the proper resignation request includes the following: 1. Membership dues and any service fees (NSF) must be paid in full upon request of resignation. 2. A minimum 30 days notice must be given in writing, during which time any payments that fall due must be paid. 3. If further information is required, a Membership Service Representative may contact you within 14 days to discuss the resignation request. Has the above member completed the term of his/her contract? YES NO Fee applicable to this agreement: $. This fee must be paid prior to cancellation. If it is not paid, the cancellation will not be completed.
In order for us to improve the club, we would appreciate your honesty as to why you wish to resign. Your comments are greatly appreciated. Reason for resignation:
Member Signature*

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Today's Date*

MonthDayYear
Date
Attention! Signing this form does not guarantee approval. It is the first step in informing us of your request. Your account remains active until you receive a confirmation email or a call from us, notifying you of the approval or denial, along with any outstanding amount owing.
Member Acknowledge Signature*

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