My Y Story

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Area Code

Phone Number

4

Your Y Location* This field is required.

Cassville YMCA

Dallas County Area YMCA (Buffalo)

G. Pearson Ward YMCA (Downtown Springfield)

Lebanon Family YMCA

Monett Family YMCA

Ozark Mountain YMCA (Hollister)

Pat Jones YMCA (Republic Rd. Springfield)

YMCA Camp Wakonda

YMCA School Age Services (Summer Day Camp, Before and/or After School Care)

5

Are you a Y member Y participant or a Y Staff Team Member?

Y Member

Y Staff Team

Y Participant

6

What is your Y Story?

7

What brought you into the Y?

8

How long have you been a member / staff?

9

What does the Y provide to your life?

10

What is your best Y memory or moment?

11

What do you think people should know about the Y?

12

Do you currently or have you ever received financial assistance from the Y?* This field is required.

YES

NO

13

Would you be willing to share your story on Video* This field is required.

YES

NO

14

Is there anything else you would like to add?

15

Picture upload

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Max. file size: 10.6MB