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, 2019. 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
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 with any questions. Mitch Silverstein – silverstein_m [at] yahoo [dot] com.
For Pool Use Only
Cert#________Date Received :________Refund Amt $:________Refund Check No.: ________