Membership Change Form

I need to update my personal information such as name, email, phone number or address
I'd like to make the following changes to my membership

Change My Membership TypeChange My Bank Draft InformationAdd or Remove people from Membership
I'd like to make the following changes to my membership

Change My Membership TypeChange My Bank Draft InformationAdd or Remove people from MembershipAdd or Remove Services from my Membership

Change My Bank Draft Information
My new billing method is*

Checking AccountSavings AccountCredit Card ($3 additional monthly fee)
The last 4 digits of my updated checking account are*
The last 4 digits of my updated savings account are*
The last 4 digits of my updated credit card are*
*Payment methods must be presented to membership staff at the time of membership changes*

Comments or special requests for YMCA staff
I/we hereby authorize the YMCA of Greater Tulsa to initiate debit entries to my/our checking/savings/credit account as entered on the preceding pages to deposit the same amount into the account of the YMCA of Greater Tulsa. A valid check or credit/debit card must be presented when joining. This authority is to remain effective until written request for termination is received a minimum of 30 days prior to the draft.

I understand that bank drafts will be initiated on the 5th or 20th of each month, and that a $25 return fee will be charged for each declined payment, including those made by check or credit/debit card. I understand that membership dues are subject to change with a minimum 30 days’ notice, and that refunds may not be issued for charges older than 60 days. I further understand that a $3.00 convenience fee is accessed on each credit/debit card transaction. If the card is drafted monthly, that $3.00 fee will be assessed each month.
SIGNATURE*

Clear
DATE*

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Date
Should be Empty:

Change My Membership Type