Sec/Treas Chapter Status Report

EmailMeForm

Chapter Name *
Your Name *
First Last
Your Email Address *
Date this form is being submitted: *
MM / DD / YYYY
Member's Name *
First Last
There are three ways a member is removed from the chapter roster.

1. The member drops their membership or chooses not to renew their membership.

2. The Membership Committee terminates the membership.

3. The Membership Committee does not approve renewal of membership.
Member DROPPED for the following reason:
This allows the regional office to track by reason so that we can work to help with retention in the region.
Membership Committee TERMINATED the membership for the following reason:*
*Notify your Chapter Director BEFORE notifying the member.
Membership Committee DENIED RENEWAL for the following reasons*

Lack of Participation

Lack of Referrals Given

Lack of Visitors Invited

Other

*Notify your chapter director BEFORE you notify the member
Member needs to be removed from the chapter Roster as of: *
MM / DD / YYYY
Any additional information to provide the Director Team
The Membership Committee feels that this member left in good standing and is eligible for a certificate of credit of any remaining months of membership. *

Yes

No
Medical Leave: Vice President to record “M” on the weekly PALMS report. No additional reporting to the Regional Office is required.

Classification Change: Member must submit New Member Application to the chapter for approval by the Membership Committee. Have member write “Classification Change Only” on application. Forward approved application to Regional Office.

Company Rep. Change: New Company Representative submits New Member Application to the chapter for approval by the Membership Committee. See Fee Matrix for any applicable fees. Have member write “Company Rep Change” on application. Forward approved application to Regional Office.

Member Changes Jobs: New Member Application is submitted to the chapter for approval by the Membership Committee. See Fee Matrix for applicable fees. Forward approved application to the Regional Office.

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