MEMBERSHIP HOLD FORM
Street Address Line 2
State / Province
Postal / Zip Code
I would like to put my membership on hold (indicate length of time below).
Your membership will resume and your account will be automatically drafted after this hold period ends.
If your hold request is less than 1 week prior to your draft date, you may be drafted 1 more time. (If you do not know your draft date, please call the membership director)
If you want to reinstate your membership at any point during the hold, you should contact the membership director at the Y.
If you choose to cancel your membership during your hold period, you must complete the online membership cancellation form.
If you have extenuating circumstances and need to extend your hold, please contact the membership director.
I would like to make a charitable donation to the Y Partners Annual Campaign. The amount will be drafted from your account.
Enter 0 if you are unable at this time.
Should be Empty: