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This form is to be filled out only if you are choosing to terminate your membership.

Please attach your bond to this form, if a paper bond was issued, and send to the address below no later than March 15, 2021. If not received by this date, a late fee of $50 will be deducted from your bond refund.

Maggie Stephey

Membership Chair
801 McComb Ln
Chadds Ford, PA 19317


I, (write name which appears on Certificate):________________________________________________

of (write full address):____________________________________________________________________

request that our membership in the Green Woods Club, Inc. be terminated.

Signature of Certificate Holder: ______________________________________Date:___________________

Phone: _______________________________________ Email Address: _____________________________

If you are moving and would like the refund check sent to your new address, please complete:

New Mailing Address: ____________________________________________________________________

New Phone:______________________________________


Please Note The Following:

Your refund will be issued to you upon the sale of your bond. You should expect a refund by mid-June. If you are unable to find your bond, please complete the Lost Bond Waiver Form. Contact the membership chair, Maggie Stephey, with any questions.

 For Pool Use Only

Cert#________Date Received :________Refund Amt $:________Refund Check No.: ________