Member Data Removal
This form is to be completed to confirm the removal of a members data.
Membership Secretary Name
*
First Name
Last Name
Member's name to be deleted
*
First Name
Last Name
Membership Number
*
Members Email
*
example@example.com
Additional Comments (optional)
Date of Data Removal
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I confirm that all data related to the above member has been removed from our systems.
*
Yes
Submit Confirmation
Should be Empty: