CMMOTA Membership Cancellation Request Form
Personal Information
Full Name
*
First Name
Last Name
Personal Email
*
example@example.com
Date of Birth
*
/
Month
/
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
CMMOTA Member #
*
Home Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Back
Next
Requested Class of Membership to Cancel
Please Select
Full/RMT/Spa
MOT
Student RMT
Student MOT
Associate
Requested Date of Cancellation
-
Month
-
Day
Year
Date
We are continuously striving for excellence in customer service and would appreciate knowing why you are choosing to cancel your membership with us. Please select any of the following that apply to you:
*
Changing Careers
Withdrew from School
Health/Personal Reasons
Retiring
Moving
Switching Associations
Unsatisfied with CMMOTA
Prefer not to disclose
Other
Please provide a reason for your membership cancellation:
*
Signature (Typed name is considered digital signature)
*
First Name
Last Name
Today's Date
*
/
Month
/
Day
Year
Date
SUBMIT
Should be Empty: