Date *

MM

DD

YYYY

Joint Membership *

Yes

No

Name of Member *

I request permission from the Rocky Point Club Board of Governors to change my membership status to that of Inactive. I hereby certify that I understand the requirements for such membership status as set forth in the Rocky Point Club bylaws and will fulfill all conditions set out therein. I further state that I will comply with the regulations stated in the by-laws and with the provisions of the Neighborhood Agreement governing the new status.

First Name

Last Name

2nd Member's Name (if Joint)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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