610-388-6787 (summer season only)

Membership Termination Form

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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 and send to the address below no later than March 1, 2017. If not received by this date, a late fee of $50 will be deducted from your bond refund

Mitch Silverstein

Membership Chair
127 Ashford Drive
Chadds Ford, PA 19317

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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:______________________________________

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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 with any questions. Mitch Silverstein – silverstein_m [at] yahoo [dot] com. There is a $25 fee for this procedure.

 For Pool Use Only

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