SUSPENSION and CANCELLATION OF MEMBERSHIP APPLICATION FORM

Member's Name: Keyfob #

Email Address: Contact No:

Membership Status and Terms: Remaining Months

Date of Request: Status of Request:

SUSPENSION Duration:

CANCELLATION Effectivity Date:

REASONS:

Medical Travel Lack of Motivation

Competition Death Bad Experience

Requirement/s:

Medical Certificate / Medical

Other Requirement/s:
History

Proof of Any Relocation Documents (Plane

ticket, Billing address etc.)

This is to certify that the above details are true and correct.

Member's Signature over Printed Name Witness (STAFF)

Date Processed:

Signature over printed name Area Manager / NOM/Director

Processed by: (transacted In Membr.com) Approved By: