Birthdate:*
Home YMCA Facility:
Membership Reason for Cancellation:
Cancellation Person to Remove:
Cancellation 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.
*