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

First Name:*
Last Name:*
Phone number:	()-First three digitsSecond three digitsLast four digits
E-mail address:*
Spouse (if any)'s Name:
We wish to:*	Resign Request higher membership level If resignation, answer next question. If higher membership request, skip next question and continue.
What are your reasons for resigning?:	Skip down and Submit.
Membership level chnage requested:	Active to senior Senior to super senior Super senior to honorary See requirements above.
Month/year joined club:
Date of birth of qualifying spouse:
Date of birth of youngest child: