Eau Claire YMCA Membership Cancellation Notice

YMCA of the Chippewa Valley Membership Cancellation Notice
NOTICE: No matter the draft date, memberships are paid for the current month. Your membership will be valid until the end of the month in which you submit your cancellation. The following month is when your cancellation will take effect.

Example: If your membership draft date is the 10th of each month and you submit your cancellation on the 5th, you will still be drafted and your membership will remain valid through the end of the month.
First Name *
Last Name *
Street Address *
YMCA Home Branch *
City *
State *
Zip Code *
Phone Number *
Best daytime phone
E-mail Address *
Additional names on the membership
Membership Type *
Are you enrolled in Specialty Fitness? (This will cancel at the same time) *

Yes No
Do you have a locker reservation? *

Yes No
Locker Number(s)
Please remove belongings within 7 days of cancellation
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 by the end of the month, one month prior to when the cancellation takes effect in order to cancel the next draft and that there are no refunds for unused memberships. 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.
Signature

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