OLBA-Refund Request & Payment Form

1) Request for Affiliation Fee Refund

2) Payment of Additional Affiliation Fees

Club Number: Click here to enter text.

Club Name: ________________________________

I was assessed $ ________ for _____ Active members @$31.00 per active member

As of ______________________ we had _________ ACTIVE members (including

Life members who bowl, but excluding Associate or Duplicate members who pay affiliation fees to another club

CHOOSE ONE OF THE FOLLOWING:

1)	Please refund $____________	($31 x________)

Send request for refund no later than August 31st.

2) I enclose $____________ for additional affiliation fees	($31 x _____)

Please forward to:

Elaine Stevenson

OLBA Data Base Administrator

38 Geo Izatt Dr, Uxbridge ON L9P 0A4

membership@olba.ca

OLBA-Refund Request & Payment Form