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REQUEST FOR THE CHANGE OF SPONSORSHlP OF A LIFEWAVE BUSINESS CENTER


Once Completed Fax to 678- 730-2980

Member Signature ~

I request to move (Member #): ((:) 9 <..¡ w'1 S to:

(Circle one): Left/~f __ _ __ ' to be sponsored

By (Member#) C; 99008
***Memberwiil be moved to the bottom oUbe sponsor's Jeg that is circled***

1 request to change Sponsor's for the following reasons:

Signature ofCurrent Sponsor ~>(~' ~,

Print name ofSponsor )) d:1/ ,J1.,_~S~.A_A)__'('__k'_"'t'_" :¿~_Co=:""",,-,'.,-",e,-,J"-.,,/Jc-'V'W=-' '-"--_{¡!-'#CL' G9 '1 <;:, 1S) S rc:'JJo:z

Signature of Sponsor site is being transferred to

***Note: All flelds are necessary to complete your order.

Credit Card Type: Visa / MasterCard

Credit Card Number:

First Name on Credit Card: _

Last Name on Credit Card:

Expiration Date: _

Security Code: _

Enter the address where you receive your credit card statement

Streetaddress: <:/E'I'1¡(¡'
, ~(vL¡,/{:1 of¿ 1/1(. (.4/., 8
City: CÓ,141Vc. ~~'-- _

State: _> $,,,:4.4 e é~(~.Q~'--"v,--4~, _

Postal Cede: _---'Ú""'-'[j.¿'.---''-r'--Q-=-··~~_'___~ ~ _

Phone: 00 :1't . 0 3Q'TL~~?L>"-.II.:../-'Fu(c-- _

By signing this requesr form the member agrees to a processing fee of ñfty dollars ($50.00) for rhís move. The fee
is applícable regardless of time the request was submitted.

Signature of Member: __ ~> Date: ~

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