EmailMeForm
BNI NW Florida Member Status Report
This form provides notification to the Regional Office of roster changes. Please use one form per membership change.
Today's Date
*
MM
/
DD
/
YYYY
Chapter Name
*
Report Submitted By
*
Please select
Secretary/Treasurer
Vice President
Membership Committee
Chapter Director
Regional Office
Your Name
*
First
Last
Your Email Address
*
There are three ways a member is to be removed from the chapter membership roster.
1. The member resigns their membership or chooses not to renew.
2. The Membership Committee terminates the membership.*
3. The Membership Committee declines the member's renewal.*
*Required Director Approval
Member's Name
*
First
Last
1. Member RESIGNED for the following reason:
Select if Applicable
Economic Distress
Changed job
Did not renew
Left company
MSP not completed
No reason given
Lack of referrals
Not right fit with company
Personal reasons
Relocated
Scheduling conflicts
Takes too much time
Transferred BNI Chapters
This allows the Regional Office to track the reason members have left the organization.
2. Membership Committee TERMINATED the membership for the following reason:
Select if Applicable
Attendance
Code of Ethics
Participation
3. Membership Committee DENIED RENEWAL for the following reason(s):
Lack of Participation
Lack of Referral Given
Lack of Visitors Invited
Other (provided addtional details below)
Effective Date of Member's Drop:
*
MM
/
DD
/
YYYY
Enter the date of the member's last meeting OR date in which the chapter terminated the membership. If the member submitted a resignation letter please copy/paste the notice in the Additional Information box below.
Additional Information:
Was the member in good standing with the chapter upon their departure?
Yes
No
