Ymca Membership Cancellation Request Form

MANKATO FAMILY YMCA

Staff Use ONLY

1401 South Riverfront Drive

FT ID#_________________________

Mankato, MN 56001

Membership Begin Date:_______________________

(507)387-8255

Last Draft Date:________________________

Date to Cancel:________________________

Staff Initials:___________________________

MEMBERSHIP CANCELLATION REQUEST FORM

(All applicable information must be filled out for this request to be processed)

______________________________________________________________________________________________

__________________________________________

Last Name

First Name

Middle Initial

Membership Type

____________________________________________________________________________________________________________________________________________________________________________________________

Mailing Address

City

State

Zip Code

____________________________

__________________________________________

_________________________________________________________ Draft ________ Payroll ________ Full Pay________

Birthdate

Phone

E-Mail Address

Payment Method

____________________________________________________________________________

____________________________________________________________________________

Employer (Is this a Corporate membership?)

If Youth Membership, Parent or Guardian Name

To help us ensure future quality at our YMCA, please answer the following questions:

Which of the following best describes your reason for requesting this cancellation?



_________________________



Transfer to another YMCA

Not Using



_____________________________



Relocating –Where?

Purchased own equipment





Too expensive / financial reasons.

Seasonal

Would you be interested in receiving information on our Financial Assistance membership program?  YES  NO



Joined another fitness center – Please name other facility ____________________



Other – Please tell us why:__________________________________________________________________

What was the # 1 reason you joined our YMCA?

What did you DISLIKE about this YMCA membership?

How likely are you to rejoin the YMCA?

Do you have any suggestions to help us improve our facility or programming?

Please rate each of category on a scale of 1-5, with 5 being excellent:

_____ Cleanliness of facility

_____ Staff friendliness

_____ Information availability

_____ Equipment / maintenance

_____ Staff knowledge

_____ Value of membership

_____ Quality / variety of programs

_____ Hours of operation

_____ Facility security / safety

_____ Overall YMCA operation



I understand I(we) must be a member for the duration of any programming and I will be billed for the Non-Member rate of any programs

I(we) am(are) registered for.



15 days prior to my next payment

I understand that I must cancel my membership in writing

. Refunds are not given for failure

to give the YMCA timely notice. If I wish to join the YMCA again, and more than 30 days passed since my last active membership, I

understand I will be required to pay a new association fee.

Member Signature____________________________________________________________ Date: __________________________

THE MANKATO FAMILY YMCA TRANSFER LETTER OF GOOD STANDING

This letter is to confirm that ______________________________________________________________________________has been a member

in good standing at the Mankato Family YMCA since ______________________. Date of last payment ______________________.

Membership Director: ____________________________________________________________ Date: __________________________