Membership Relinquish Form

Orinda Park Pool: Relinquish Membership

Please Fill Out All Information
Primary Member First Name (Refund Check will be made payable to this name)
Primary Member Last Name (Refund Check will be made payable to this name)
Household Member First Name (2)
Household Member Last Name (2)
All Additional Member Names
Contact Phone #

Area CodePhone Number
Phone (home or work)

Area CodePhone Number
Primary Member Email
Mailing Address (to mail refund check to)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Membership Type
If known, year in which you joined
i.e. 1998, 2011, 2003 ....
We (I am) are Proprietary Member(s) of Orinda Park, Inc., a California Corporation, and is entitled to all the rights and privileges as such conferred by, and subject to, the bylaws of the corporation, and irrevocable assent to said bylaws is given by said Member. OPP Membership may be transferred only in accordance with the bylaws of Orinda Park, Inc., a copy of which is available for inspection upon request. We certify that we are the legal members, that we have not sold, assigned or otherwise transferred the certificate or any interest therein to any other person, and that we have the right to relinquish such certificate and receive, if any, proceeds,in accordance with the by-laws of Orinda Park, Inc.
Electronic Signature being Submitted
Certificate Holder's Signature
Please type in Name of Signature
Date

MonthDayYear
If you are submitting this form electronically, please check the electronic signature box then type your name in the signature box. By doing so you are authorizing Orinda Park Pool to use your authorized "electronic signature".
Should be Empty:

Orinda Park Pool: Relinquish Membership