Eau Claire YMCA Membership Cancellation Notice

YMCA of the Chippewa Valley Membership Change Form
Current Information

Keeping your information up to date helps us stay connected so you don't miss a thing!
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Street Address*
City*
State*
Zip Code*
Phone Number*
E-mail Address*
Home Membership Branch
Membership Changes and our Program Pricing Policy

ProgramPricing Policy General Program ParticipationNot all programs at the YMCA of the Chippewa Valley require an activemembership to participate. However, if a participant registers under an activemembership and receives the discounted member rate, then cancels theirmembership during the program session: Participation may be forfeited OR the participant will be back-charged the difference between the member and non-member rate. Program participation will be suspended until the outstanding balance is paid in full. Competitive Team ParticipationAn active YMCA membership is required for all participants in the YMCABarracudas Swim Team and the YMCA Jr. Blugold Gymnastics Team. Membership must be active at the time of registration and remain active for the entire duration of the registered session(s). If a participant’s membership becomes inactive before or during a program session: The participant will be back charged for any missed membership dues. Program participation will be suspended until payment is received and membership is reinstated.
Options

Select one heading and fill out completely. If you wish to cancel your membership, please visit www.ymca-cv.org > Membership > Account Services and scroll to the cancellations and refunds section.

Upgrade/Downgrade Membership
NOTE:

Upgrades and downgrades will take effect on the 1st of the month. If you would like up upgrade before the 1st, prorated charges for the difference will apply. No refunds will be given for downgrades.
Change my membership type
from
to
When would you like this change to start?

MonthDayYear
Changes must be applied by the 1st of the month to ensure accurate status and fee for that month.To upgrade immediately, you will be charged the prorated difference in membership cost. No refunds will be given for downgrades. Family memberships are limited to 2 adults of the same household and their dependent.
Please list everyone on the membership and include their date of birth:
Example: John Smith 12/02/2004
Questions, comments or additional information:

Add/Remove Household Members
NOTE:

A household membership is defined as 2 adults and their dependents living at the same address. The YMCA may require proof of address before making changes to a household membership.
Choose:
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Choose:
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Choose:
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Choose:
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Questions, comments or additional information:

Request for Membership Hold
NOTE:

Memberships can be placed on hold for up to 3 months. After the 3 months, the membership will automatically start back up and draft with the original rate, date, and frequency of the held membership. Holds will start on the 1st of the month.
Place my membership on hold
Start Date

MonthDayYear
When your membership will become inactive
End Date

MonthDayYear
When your membership will re-activate
Please indicate the reason for your hold:
Example: vacation, work, medical restrictions, etc.
Questions, comments or additional information:

Waivers
Acknowledgement
Membership Dues Agreement: Members understand that all changes affecting their monthly draft, (i.e. billing information, holds, downgrades, termination) require a written notice before the end of the month prior to their next draft date. Any error must be identified no later than 60 days from the posted bank statement date. The YMCA is not responsible for errors occurring later than 90 days from the date of the initial error. The YMCA draft is a continuous membership plan. Memberships will remain in effect until properly terminated with the YMCA. The YMCA may, at their discretion, adjust the monthly membership rate applicable to the category of membership. Members will receive at least a 30-day notice of the change before a debit occurs at the new rate. The primary membership holder is fully responsible for their membership and for all persons associated with their membership, including their knowledge of the aforementioned policies and liability waiver. Member is responsible for providing accurate contact information including updated address, phone number, email address, and billing information including expiration date and account information.

Membership status changes: Changes to your membership, including additions and deletions and change in membership type must be processed by Members Services in writing. Family memberships apply to households with a maximum of two adults residing at the same address and children residing at the same address who are up to the age of 24, if a full-time student, and up to the age of 19, if not a student.

Request for Membership Hold: Memberships can be placed on hold for up to 3 months. After the 3 months, the membership will automatically start back up and draft with the original rate, date, and frequency of the held membership. Additional changes to the membership need to be submitted before the membership is released from hold. No refunds will be given if the member does not communicate changes before the release date.
By checking the box below, I have read and understand the policy above.*

I agree.
Signature*
YMCA of the Chippewa Valley | www.ymca-cv.org
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Current Information

Membership Changes and our Program Pricing Policy

Options

NOTE:

NOTE:

NOTE:

Acknowledgement