Please fill out the form, print off and mail or fax to Paramount along with the cancellation requirements stated below.

DATE: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

ADDRESS:

RE: REQUEST FOR CANCELLATION OF MEMBERSHIP# CADA-Canyon Meadows CADB-Northeast CADF-Westbrook EDEA-Westgate EDEB-Heritage EDED-Northgate

NAME:

In order to cancel your contract for medical reasons, we require the following:

1. Letter from a physician stating the medical condition in compliance with the definition stated on the contract or click here to review the Medical Cancellation Policy.

2. Cancellation fee of $150.00. (Only money orders accepted)

3. Monthly payments that are past due or become due prior to cancellation.

When all requirements have been received your membership will be reviewed for cancellation. You will be notified once processed.

Prompt attention will avoid further monies becoming due.

Signature:_____________________________________

SEND ALL MAIL REGISTERED TO AVOID COSTLY DELAYS