Dear Chairman Board of Elders,. I am writing to withdraw my membership from Grace Community Church.Write a letter to or call the church's office and ask to withdraw membership and remove your information from their records. You can always write a formal letter to your local church board stating your request and the reasons why. Several people have recently indicated they became church members. INSTRUCTIONS: Fill out this Declaration completely and provide accurate information. Make at least one copy. Members who terminate from Pima County prior to completing the vaccination series shall be responsible for completing and paying for the series.