Membership Request-to-Cancel Form

First & Last Name *

Company *

Email Address *

Phone Number *

How long was the business associated with your membership a member of One Acadiana? *

Enter required value 1-3 years 4-10 years 10+ years Unsure

Think about the different member benefits. Select which of the following was most important to you. *

Enter required value Networking Community Engagement Business Resources Marketing Opportunities Other

How often did you dedicate time to participate in 1A events, programs, functions? *

Enter required value Regularly - Muliple times per month. Often - At least one per month. Sometimes - Every now and then. Not Often - Once every three months. Rarely - Once in a blue moon. Never

If you did not participate in 1A functions, please indicate why. *

Too busy

At inconvenient times

At inconvenient locations

Not interested in topics

Uncomfortable with people I don’t know

Did not join 1A to attend functions

How much did you benefit from your 1A membership? *

Enter required value A great deal A good deal Somewhat Not much Not at all

How satisfied were you with your membership experience? *

1- Extremely low. 5- Extremely high.

1

5

Why did you decide against renewing your 1A membership? *

Enter required value Your business merged, moved, closed, or changed ownership Cannot afford membership dues Not benefitting No time to get involved Other

Did any external factors influence your decision? *

For example: business closure, relocation, leadership change, etc.

Enter required value Yes No

Is there anything we can do to keep you as a member? *

Enter required value Yes No

If yes above, please specify how we could keep you as a member below. *

What is the likelihood of you getting reinvolved with One Acadiana in the future? *

0- Not likely at all. 10- Extremely likely.

0

10

Do you have any other feedback? How can we improve? Tell us what's on your mind. *

Do you acknowledge and agree to the following: *

• I understand that submitting this form serves as a request to cancel my company’s One Acadiana membership and that membership benefits will end once the cancellation is processed.
• I confirm that I am authorized to submit this request on behalf of my organization.
• I understand that One Acadiana may contact me to follow up on this request or to discuss my responses.
• I acknowledge that any outstanding balances, if applicable, may still be due in accordance with One Acadiana’s membership policies.
• I understand that submitting this form does not guarantee immediate cancellation and that a confirmation may be provided once the request has been reviewed.

Enter required value I acknowledge and agree to all of the above terms.