Membership Cancellation Form
Monthly membership drafts continue until the member notifies the Y they wish to terminate the membership. Membership is not dependent upon usage. Member is responsible for making any changes to membership.

ALL CANCELLATION NOTICES MUST BE SUBMITTED NO LATER THAN THE 25TH DAY OF THE CURRENT MONTH IN ORDER TO CANCEL THE DRAFT SCHEDULED FOR THE FOLLOWING MONTH.

Note: All membership payments are for membership in the month the draft was drawn. 

I understand that this termination will stop all future automatic withdrawals related to my YMCA membership. 
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Email *
Members First and Last Name *
Members Street Address *
Members Phone Number *
I would like to: *
Required
Reason why I am canceling my membership *
A copy of your responses will be emailed to the address you provided.
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