Membership Cancellation Form
Auburn YMCA- WEIU
This form may be used to cancel monthly recurring membership at the Auburn YMCA- WEIU. This form is not applicable to annual pay membership or program registration. Please Complete this request. You will be contacted by our Member Services Team who will confirm your request.
Name
First Name
Last Name
Membership ID
Phone Number
Email on File with Your Membership
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cancellation Date
-
Month
-
Day
Year
Date
Reason for cancellation (in paragraph)
Financial situation, health related, staff issues, facility issues
How would you rate our overall services?
1
2
3
4
5
Provide any comments or feedback
Terms and Conditions
Cancellation of this membership will not be considered complete until our Member Services Team confirms that your request has been processed.
This form does not accept cancellation of program registration or annual membership.
Our membership team will process membership cancellations. It is important to note that this form does not communicate directly with the payment processing center and should not be considered a means to stop a payment automatically.
Per our membership contract, the Auburn YMCA e requests a 14-day notification of your desire to stop your membership.
This request will not be processed outside of standard business hours M-F.
By submitting this request, I am indicating that I am the owner of this account and, as such, have the right to terminate this membership.
For individuals who have Health Center Memberships, please note that the keys are the property of the Auburn YMCA and must be returned immediately upon cancellation.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
Authorized Use Only
Approved By
First Name
Last Name
Approver's Signature
Date Signed
-
Month
-
Day
Year
Date
Should be Empty: