Birthdate:
Home YMCA Facility:
Cancelation Person to Remove:
Cancelation Type:
Membership Reason for Cancellation:
Cancelation Additional Information:
I understand changes to my membership account must be received by the 25th day of the month in order to ensure no charges will take place in the following month. If a membership lapses for more than 30 days, a rejoining fee will apply.

Yes, I acknowledge the above hold statement pertaining to my cancellation request.

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