Membership Hold/Cancellation Form

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Please enter your information:* This field is required.
First Name
Last Name
Phone Number
Email Address
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Date of Birth
Date of Birth (MM/DD/YYYY)
Month
Day
Year
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Home YMCA Facility* This field is required.
Bremerton Family YMCA
Gordon Family YMCA
Haselwood Family YMCA
Lakewood Family YMCA
Mel Korum Family YMCA
Morgan Family YMCA
Tacoma Center YMCA
Tom Taylor Family YMCA
University Y Student Center
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Would you like to hold your membership?* This field is required.
YESNO
5
Would you like to cancel your membership?
YESNO
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Why are you holding your account?* This field is required.
Financial Issues
Medical
School
Seasonal
Vacation
Work
COVID-19
7
Reason for cancellation* This field is required.
Financial Issues
Medical
School
Seasonal
Vacation
Work
COVID-19
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How many months would you like to place your membership on hold?* This field is required.
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
9
Any additional information we should know?
10
Any additional information we should know?
11
PLACING YOUR MEMBERSHIP ON HOLD

Memberships may be held for up to six months in a calendar year. Requests must be submitted to the Y by the 25th of the month prior to the month the hold is requested. Holds take effect on the first of the month and end on the last day of the month. Membership holds must be for all active people on a membership unit. Members may take their account off hold at any time during the hold period. They then pay the prorated amount for the rest of the month and begin drafting the following month.
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I understand changes to my membership account must be received by the 25th of the month in order to take effect the 1st of the following month. I also understand my normal membership dues will automatically restart after my hold period has ended. Signature* This field is required.
Clear
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I understand changes to my membership account must be received by the 25th day of the current month in order to take effect the following month. If a membership lapses for more than 30 days, a rejoining fee will apply. Signature* This field is required.
Clear
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PLACING YOUR MEMBERSHIP ON HOLD