BNI NW Florida Member Status Report
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chapter Name
*
Report Submitted by: (please include your leadership role Position)
*
Email
*
example@example.com
Members Name
*
Member RESIGNED for the following reason:
*
Effective Date of Member's Drop
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Any additional information
Was the member in good standing upon their departure?
*
Yes
No
Submit
Should be Empty: