YMCA Membership Change Request

YMCA Membership Change Request
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Branch
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Cancelations and holds must be submitted by the last day of the month.
What Change Are You Making?
CANCELLATION POLICY:

Cancellations take effect at the end of the current month. Even if your cancellation is submitted before the scheduled draft date, members are still responsible for that month's membership fee. No additional fees will be charged beyond the current month.

IMPORTANT: Any outstanding balance must be paid in full before the cancellation is finalized.

If you are considering cancelling due to extenuating circumstances including medical necessity, you might want to consider placing your account on hold instead of cancelling. Please review our Hold Policy before deciding what is right for you.

Did you know? Thanks to the generosity of our donors we are able to offer member support to those who cannot afford memberships. Please consider applying for member support using this link.
VACATION HOLD POLICY:

Please note: Holds can only be placed for a maximum of 6 months consecutively.

Your account will be charged $5 per month to be paid in a lump sum at the beginning of your hold. Holds can only be scheduled to start on the first day of the month. However, if you come back early we apply any extra money paid up front as a prorate so you can restart your membership right away!

IMPORTANT: your account will automatically become active at the end of your hold period; you will be charged full price unless you extend your hold or cancel. The Annual Equipment and Facility Fee will still be charged during holds that take place during the fee period.
MEDICAL HOLD POLICY:

Please note: Holds can only be placed for a maximum of 6 months per year and the hold period can only start on the first day of the month

Your account will not be charged during this time. If you come back early we will prorate you for the rest of the month so you can restart your membership right away!

IMPORTANT: your account will automatically become active at the end of your hold period; you will be charged full price unless you extend your hold or cancel. The Annual Equipment and Facility Fee will still be charged during holds that take place during the fee period.
Please share why you are canceling your membership:

Other
Additional comments
What date would you like this to take effect?
What date would you like your membership to be taken off hold?
I acknowledge the above policy regarding cancelation and verify that I want to cancel my membership
I acknowledge the above hold policy and verify that I want my account placed on hold between the dates listed above. I give permission for the YMCA to charge me full price if I do not cancel or extend my hold by the end of the hold period
Should be Empty:

YMCA Membership Change Request

Cancelations and holds must be submitted by the last day of the month.