Montgomery Ymca Membership Cancellation Form printable pdf download

Montgomery Ymca Membership Cancellation Form

Montgomery YMCA

Membership

Cancellation Form

Last Name

First Name

Middle Initial

Street Address

Daytime Phone

City

State

Zip Code

Is anyone on this membership currently participating in a program? (Aerobics, swim lessons, etc.) Yes /No

Please help us improve our membership services by indicating your reason for canceling

your YMCA membership.

Relocation

Military Transfer

No longer using the facility – explain below

Financial Burden

Unsatisfactory (Facility) – explain below

Medical Reasons

Unsatisfactory (Service) – explain below

Joined another club/facility

Name of facility__________________

Comments/Other___________________________________________________________

_________________________________________________________________________

_____________________________________________________________________

The Montgomery YMCA makes every effort to stop bank drafts promptly. However, your account may be

drafted once more, as bank drafts usually take 30 days to cancel as specified in the YMCA policies listed on

the authorization agreement for your preauthorized payments. If we are unable to stop your draft, you will

be free to use our facilities until the end of that month. If you have questions, or we can be of further

assistance, please contact our membership administrator in the Metro business office at 334-269-4362

between the hours of 8:00 AM and 4:00 PM. Thank you for your support and we look forward to serving

you again in the future.

Member Signature

Date

YMCA Employee’s Signature

Date

For office use only:

ID# of the billing member:____________

Date of Last Draft: ________________

Membership Type: _________________

Home Branch:_____________________

__________

White Copy- Metro

Yellow Copy- Branch

Pink Copy- Member

Montgomery Ymca Membership Cancellation Form

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