Ymca Of Emporia-Greensville Membership Cancellation Form printable pdf download

THE FAMILY YMCA OF EMPORIA-GREENSVILLE

MEMBERSHIP CANCELLATION FORM

(CANCEL MEMBERSHIP)

NOTE: Recurring memberships run from the first through the last day of each calendar month. Membership drafts delayed

until the 15th of the current month WILL STILL OCCUR.

Name of Primary Adult Member:

Primary Adult Member Date of Birth:

Reason for



Family relationship

Child aged out of

Switched to another



No longer using facility

change

family

facility

dropping



Dissatisfied with

Drop for summer or

crowding

program offering

facility

winter

membership:



Hours of operation

Lost motivation

Equipment Availability

Medical reasons

Please use the back of this form



Financial Reasons

if you need to expand on your

(Did you know we offer



answer.

Unsatisfactory facility

Relocation

Deceased

reduced fees based on

household income? Ask for

details if you wish to apply.)



Unsatisfactory service.



Other. PLEASE EXPLAIN

PLEASE EXPLAIN

I authorize the Family YMCA of Emporia-Greensville, Inc., and my financial institution to stop my monthly draft/charge drawn on my account by the Family

YMCA of Emporia-Greensville, Inc. for membership payment effective the first day of next month. This action will cancel my membership with the YMCA

effective the last day of the current month. I understand that my membership runs from the first day of each calendar month through the last day of each

calendar month and if my draft for the current month is scheduled for the 15th, it is still due and will be drafted. Should any draft/charge not be honored by

my financial institution, I understand that it is still my responsibility to make payments for all fees due, including any fees not covered by the bank. The Family

YMCA of Emporia-Greensville, Inc. has the right to redraft/recharge any account that had non-sufficient funds. The YMCA reserves the right to charge a fee

equal to the maximum allowed by the Commonwealth of Virginia for non-sufficient bank drafts and/or credit card returns. I understand that I may be required

to pay another Joiner’s Fee if I rejoin after a 30 day lapse in membership. REMINDER: Recurring memberships run from the first through the last day of

each calendar month. Membership drafts scheduled on the 15th will still occur for the current month.

SIGNATURE

DATE

Received at YMCA by

Date

Change entered into Member ST by

Date

I/We valued my/our experience at the YMCA

Strongly Agree

Agree

Disagree

Strongly Disagree