MEMBERSHIP CANCEL/HOLD REQUEST

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

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

CancelHold
Length of Membership Hold*
I authorize the cancellation of my membership with the YMCA. I understand that it takes 5 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 5-day notice. If I choose to rejoin within 60 days of the expiration date, the joiner fee will be waived.
I authorize a hold of my membership with the YMCA. I understand that it takes 5 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 request to cancel my membership at least 5 days prior to the last day of my hold period.
Member Signature (REQUIRED for cancellation/hold to be processed.)*

Clear
Today's Date*

MonthDayYear
Date
What is your primary reason for cancelling/suspending your membership?
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:
We welcome and appreciate your feedback.
Should be Empty:

MEMBERSHIP CANCEL/HOLD REQUEST

GREATER JOLIET AREA YMCA