MEMBERSHIP CHANGE REQUEST

This form may be used only during the April or October change periods

During April or October, members may choose to resign or request a change in membership status to Senior, Super-Senior, or Honorary, for those who qualify. For details on the requirements, please check the Bylaws. and the summary in this chart:

Requirements for membership level increases	Senior	Super Senior	Honorary
Minimum age of at least one spouse	55	70	75
Minimum years of membership	10	25	30
Minimum age of youngest child/stepchild	18	18	18

Resignation or Level Change

My First Name:*
Phone number:	()-First three digitsSecond three digitsLast four digits
E-mail:*
dSpouse (if any)'s name:
We wish to:*	Resign Request higher membership level If resign, supply reasons in next box, and then skip down to Submit. If not resigning, skip Reasons box and continue.
Reasons for resignation.:	-------------------------------------------------------
Change request:	Active to Senior Senior to Super Senior Super Senior to Honorary Requirements are shown in the above chart.
Month/year joined Club:
Date of birth of eligible spouse:
Date of birth of youngest child: