Winona Family YMCA Cancellation Form

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Please complete this form to cancel your membership. Only one form is needed for a Family membership. Form must be submitted by the 20th of the month prior to your next draw date. Membership cancellation will be set for the last day of the month.

If you are canceling your membership for only a few months, an alternate option is to place your membership on hold. This can be set up by submitting a Hold Form.

If you are terminating your membership due to financial concerns, please look over our Financial Assistance information on our website.

If you do not have an email address, or do not have access to a printer and would like a printed copy of this completed form, please enter "info@winonaymca.org" in the email field below.

Email *

First Name *

Last Name *

Birth date *

YYYY

Phone number *

Month for Cancellation to take place (please note Form must be submitted by the 20th of the month prior to your next draw date to cancel for the next month. ) *

Reason(s) for canceling your membership - please choose all that apply *

Dropping for the season/Seasonal

Medical

Switching to another facility

Monetary/financial reasons

Relocation/Moving out of area

Lack of use/Not using the facility

Not satisfied with the equipment

Not satisfied with the facility

Not satisfied with the programs

Facility cleanliness

Changing to insurance-based membership

Other:

Required

This form must be submitted by the 20th of the month prior to your next draw date. Membership cancellation will be set for the last day of the month.
*

By checking this box, I understand that all membership dues accrued on my active membership are my responsibility. I agree to pay all membership dues in full that are accrued on my membership.

Required

A copy of your responses will be emailed to the address you provided.

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