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ANNUAL MEMBERSHIP CANCELLATION FORM

Per your Annual Membership Agreement: Your membership is a ONE YEAR CONTRACT with an early termination fee (equal to your balance due). Membership automatically renews after one year. It is a member's responsibility to submit a Membership Cancellation Form in order to cancel the membership. The form must be submitted at least 10 days before your next bill, in order for the cancelation to be processed in that month.

 

Boat Storage Members: If you wish to cancel your boat storage space at NAC, you must also complete the Boat Storage Cancellation Form. Your boat must be removed from the boathouse at the time of cancellation. Please notify the front office at time of removal. 

I Agree


First Member's Name

First Name*

Last Name*
First Member's Age Acknowledgment*
First Member's Date of Birth*
I certify that I am 18 years of age or older
First Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
First Member's Signature*
Second Member's Name

First Name*

Last Name*
Second Member's Date of Birth*
Second Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Third Member's Name

First Name*

Last Name*
Third Member's Date of Birth*
Third Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Fourth Member's Name

First Name*

Last Name*
Fourth Member's Date of Birth*
Fourth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Fifth Member's Name

First Name*

Last Name*
Fifth Member's Date of Birth*
Fifth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Sixth Member's Name

First Name*

Last Name*
Sixth Member's Date of Birth*
Sixth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Seventh Member's Name

First Name*

Last Name*
Seventh Member's Date of Birth*
Seventh Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Eighth Member's Name

First Name*

Last Name*
Eighth Member's Date of Birth*
Eighth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Ninth Member's Name

First Name*

Last Name*
Ninth Member's Date of Birth*
Ninth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Tenth Member's Name

First Name*

Last Name*
Tenth Member's Date of Birth*
Tenth Member's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
The undersigned parent and/or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to release and indemnify each and all of the Released Parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said Released Parties because of any defect in or lack of such capacity to so act and release said Released Parties as specified in this Agreement. THE UNDERSIGNED PARENT AND/OR LEGAL GUARDIAN ALSO ACKNOWLEDGES THAT THEY HAVE CAREFULLY READ THIS LIABILITY RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT LINE BY LINE, THEY UNDERSTAND ITS CONTENTS AND AGREE TO BE BOUND BY THE TERMS.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Cancel Annual Membership (check one)
Auto Debit Member
Paid in Full Member
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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