Membership Cancellation Request
We sincerely hope you have enjoyed your membership with the YMCA of Greater Kalamazoo. Your evaluation and comments will help us improve our programs, services, and facilities. Cancellation must be submitted by the 25th of the month to be effective the 1st of the following month. Thank you.
Date Submitted
*
-
Month
-
Day
Year
Birthdate
*
-
Month
-
Day
Year
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Scan Card #
this is your barcode membership number
Email
*
email address we have on file
How often did you use the YMCA facilities?
*
Once a month
Less than 1x month
Once per week
2-3 times per week
4-7 times per week
What is your reason for discontinuing your YMCA Membership? Check all that apply
*
I could no longer afford the membership rate
I am dropping for summer
I am not utilizing my membership (time/schedule conflict)
I am dropping for winter
I moved. No longer close to where I live
Unsatisfactory service
Medical reasons
The facility is not well maintained
I am switching to another facility*
Membership special offer expired
Inadequate programming**
*If switching to another facility, which one?
**What programming would you like to see more of?
aquatics, health and wellness, tennis, youth sports, etc.
Would you consider re-joining the YMCA in the future?
*
Yes
No
Would you recommend the YMCA to a friend, relative, or co-worker?
*
Yes
No
Comments:
CANCELLATION AGREEMENT:
I understand that cancellation requests must be submitted by the 25th of the month to be effective for the following bank draft, and that based on my termination request date, another bank draft may be incurred.
Signature
Submit
Staff Use Only
below is for internal use
Member Unit #
Staff Initials
Effective date
-
Month
-
Day
Year
termination date
Computer change date
-
Month
-
Day
Year
Should be Empty: