Membership Hold Form

YMCA of the Twin Tiers Membership Hold Request Form

Bradford, Olean, and Wellsville
Memberships can be temporarily put on hold for documented medical reasons, military service, maternity leave, or significant financial hardships. A 14-day notice is required, and while on hold, members do not receive discounts on program fees. Holds last a maximum of 90 days per year and must be requested 15 days before the billing due date to avoid affecting the next payment.

NOTE: Should you choose to cancel your membership, you will need to complete a Membership Termination Form HERE.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*

Area CodePhone Number
1. Please tell us your reason for placing membership on hold*

Medical/Health ReasonsMilitary ServiceMaternity LeaveVacationOther
Requested hold start date (must be 14 days from today's date):

MonthDayYear
Date
Requested hold end date:

MonthDayYear
Date
Authorization: Please place my YMCA of the Twin Tiers Membership on hold. I understand that my bank (EFT) and debit/credit card drafts will automatically resume after the hold end date without notice. Annual memberships will be extended as necessary. If I wish to use the YMCA during the hold period, I must purchase a day pass or remove the hold and pay the prorated monthly rate at that time.

Clear
Should be Empty:

YMCA of the Twin Tiers Membership Hold Request Form