Members can submit this form to apply for a membership extension.

Membership extension must be applied for in advance, and cannot be applied retroactively.

Members are allowed up to 60 days of extension in each calendar year.

Member's Name

Contact Email

List Parent's contact if member is below 21 This email will be used for notifications

Contact Number

List Parent's contact if member is below 21

Reason for Extension

Starting Date of Absence

YYYY

Ending Date of Absence

YYYY