Hospitality Membership Termination Form

Full Name

First NameMiddle NameLast Name

Membership / Account Number

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Hospitality Property / Location

Preferred Contact Method

Membership type / plan

Membership start date

Date

Termination effective date / requested end date

Date

Reason for termination

Additional explanation (optional)

Termination timing preference

Stop recurring billing

Outstanding balance acknowledgement

Preferred refund handling

Return of membership items

Forwarding address for final correspondence

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

I confirm I am authorized to terminate this membership

Typed Name

First NameLast Name

Submission Date

Date