Membership change request

Name *

First Name

Last Name

Request Being Made *

(1) Month Hold

Cancel Membership

Reason for Change *

Moving Out Of Area

Medical

Vacation / Travel

Financial

Service

Other

How Long Have You Been A Member? *

Less than 3 Months

Less than 6 Months

Less than 1 year

More than 1 year

Overall Experience *

Completely Satisfied

Somewhat Satisfied

Dissatisfied

How Likely Would You Recommend ZOETIC? *

Very Likely

Not Likely

Agreement *

I understand that my request will be processed 30 days upon receipt of this request.

I understand, IF cancelling, I will lose all member benefits and all current member rates.

Refunds cannot be issued for past drafts.

Electronic Signature *

First Name

Last Name

Date *

MM

DD

YYYY