Membership Cancellation
Last Name *
First Name *
Date of Birth *
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Phone Number *
Email *
Cancellation Start Date *
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Reason For Cancellation *
Other Reason for Cancellation / Comments *
I understand all cancellations must be submitted 15 days prior to your scheduled draft date. Memberships may be reinstated within 90 days of cancellation with no join fee. Changes to accounts may be made at any time, additional fees may apply for adding members. The YMCA understands that medical, emergency and other unforeseen situations do arise and refunds may be given based on extenuating circumstances. In these cases, please contact the YMCA to discuss your specific situation. Documentation may be required in these situations.
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This form was created inside of Tillamook County Family YMCA.