MEMBERSHIP CANCEL/HOLD REQUEST

MEMBERSHIP CANCEL/HOLD REQUEST
GREATER JOLIET AREA YMCA
Select a Branch: *
Name:*
Date of Birth (for verification purposes only)*

MonthDay Year
Date
E mail:*
example@example.com
Address:*
City:*
Zip:*
I am requesting to ____________ my YMCA membership.*

CancelHold
I authorize the cancellation of my membership with the YMCA. I understand that it takes 10 days to process a cancellation. I also understand that my next membership dues will be processed and charged to my account if I have not provided a 10-day notice. If I choose to rejoin more than 60 days after my membership expires, I will be charged the joiners fee again.
Length of Membership Hold*
I authorize a hold of my membership with the YMCA. I understand that it takes 10 days to process a membership hold. I also understand that my dues will automatically be processed and charged to my account if I do not submit a cancellation request in writing to the YMCA at least 10 days prior to the last day of my hold period.
Member Signature (REQUIRED for cancellation/hold to be processed.)*

Clear
Today's Date*

MonthDay Year
Date
What is your primary reason for cancelling/suspending your membership?
Please specify*

Change in Work ScheduleCan No Longer Extend HoldFacility IssuesChild Watch Age ChangeHours of OperationMoving/MovedSeasonal Break/VacationChildren GrownFacility Too CrowdedLack of Program AvailabilitySwitching to Another FacilityCost of MembershipFacility Too FarLost JobNo Longer Using ProgramsOtherDivorceFinancial HardshipMedical ReasonsPurchased Home Equipment
Please specify*

Can No Longer Extend HoldChange in Work ScheduleChildren GrownDivorceFacility IssuesFacility Too CrowdedFacility Too FarFinancial ReasonsHours of OperationLack of Program AvailabilityMedical ReasonsMoving/MovedNo Longer Using ProgramsNot Enough Time/Too BusyPurchased Home EquipmentSeasonal Break/VacationSwitching to Another FacilityTransportation UnavailableOther
If Other or Facility Issues, please specify*
Additional Notes:
Should be Empty:

MEMBERSHIP CANCEL/HOLD REQUEST

GREATER JOLIET AREA YMCA