Y MEMBERSHIP STATUS CHANGE

Y MEMBERSHIP STATUS CHANGE

Please Complete Only the Fields You Want to Change
Last *
First *
ID#
MEMBERSHIP TYPE UPDATE:

Complete only if the following information should be changed.
Membership Upgrade to:
Additional Fees May Apply
Add the Following Members (INCLUDE DOB FOR EACH):
Additional Fees May Apply
Membership Downgrade to:
Remove the Following Members:
BILLING INFO UPDATE:

Complete only if the following information should be changed.
Payment methods must be updated in-person at the Santa Maria Valley YMCA or online via your Y profile:

https://operations.daxko.com/online/2047/Security/login.mvc/find_account
Billing Address Change
Draft Date Change

3rd 8th 19th 24th
Billing Frequency Change

Annual Semi-Annual Quarterly Monthly
LOCKER RENTAL UPDATE:

Complete only if the following information should be changed.
Add or Remove a Locker:

Add Locker Remove Locker
(Add/Remove) Locker #
Additional Fees May Apply
Select One

Women's Locker Men's Locker
CONTACT INFO UPDATE:

Complete only if the following information should be changed.
Phone #
Email
example@example.com
Street Address
City
Zip
Other Requests
By signing this form I understand that some of these membership status changes may affect my monthly fees at the Santa Maria Valley YMCA. I also acknowledge that these changes may not go into effect for up to 15 days and that any changes made after the 25th of the month will not go into effect until the following month.
Member Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

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MEMBERSHIP TYPE UPDATE: