Dear Chairman Board of Elders,. I am writing to withdraw my membership from Grace Community Church.I wish to bring to your attention a matter of personal significance- my decision to end my membership with our church. Easily withdraw your membership from a church with our free Church Membership Withdrawal Letter Template. Got my membership withdrawal letter. _____ Please withdraw my membership with the understanding that, at any time in the future, I may have my membership reinstated. _____ I now live in. Request for Withdrawal of Church Membership. 2.3.2 Complete a Patient Care Report form documenting the above and leave the PCR with the patient at the scene in a safe place. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.