Eau Claire YMCA Membership Cancellation Notice

YMCA of the Chippewa Valley Membership Cancellation Notice
First Name *
Last Name *
Membership Card Number
Street Address *
YMCA Home Branch *
City *
State *
Zip Code *
Phone Number *
E-mail Address *
Additional names on the membership
Membership Type *
Is your membership payroll deducted by your employer? *

Yes No
If you selected yes, after completing this form, please contact your employer's HR department to inform them of your membership cancellation.
I'm leaving the Y, but plan to continue to support the Y as a donor. Please keep me informed.
Please indicate your reason for cancellation, please be specific as possible. We appreciate any feedback that you can share. Select all reasons that apply. *

Moving - I am requesting a letter of transfer for another YMCA Traveling Extensively Financial Burdens Cleanliness & Maintenance Medical Reasons (Did you know you can put your membership on hold for medical reasons?) Lack of Use Scheduling & Access Programming Customer Service & Policies Joining Another Facility Lost Motivation No Longer Employee Drop for summer or winter Corporate Discount Expired
Has anyone spoken to you about our Membership For All Financial Assistance Program? *

Yes No Not Applicable
Would you mind sharing which facility you are joining?

Anytime Fitness FitELITE Cross Fit Gold's Highland Fitness Momentum CrossFit 715 Planet Fitness Rogcity Fitness Snap Fitness UWEC Crest Fitness Center 9Round Fitness & Kickboxing CrossFit Chippewa Enhance Fitness 24/7
Please provide any other feedback that will enable us to better serve our members:
I understand that a membership cancellation requires a written notice at least 10 days before my draft date in order to cancel the next draft. I understand that all annual memberships are non-refundable. I understand that I am responsible for any balance on my account and that cancellation does not eliminate any balance owed. You are responsible for your account. The YMCA will refund only one month if the deduction is not stopped when requested
By checking the box below, I have read and understand the policy above. *

I agree.
YMCA of the Chippewa Valley | 700 Graham Avenue, Eau Claire, WI 54701 | 715-836-8460
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