退会届出書.pdf

- Form Title: Membership Withdrawal Form
- Organization: Public Interest Corporation Japan Care Prevention Association
- Address: 1-1-13, Kotoh 1-chome, Bunkyo-ku, Tokyo 112-0004, Japan
- Email: [email protected]
- Annual Withdrawal:
- Check box for annual withdrawal (by March 31st)
- Unchecked box implies withdrawal on arrival date
- Lost Membership Card: Write "Lost" in the designated space
- Consequences of Withdrawal:
- No refund of paid fees
- Loss of member discounts for services
- Deadline: Withdrawal form must be submitted by March 31st
- Reasons for Withdrawal (check up to three):
① Health issues, ② Economic difficulties, ③ Family/personal reasons, ④ Other (specify)
- Withdrawal Form Details:
- Member number, date of birth, membership card number, phone number
- Withdrawal reason, name, address, date of withdrawal, signature
- Contact Information:
- TEL: 03-5615-9295, FAX: 03-5615-9296