Member Number

Enter your member number.

Branch*

Please select your branch of membership from the choices below.

Downtown Express YMCA
Hogan Family YMCA
Southeast Family YMCA

Member Name*

Please enter your Full Name.

First Middle Last

Member Email*

Date of Birth*

Enter your birthdate as MM/DD/YYYY.

Month

Day

Year

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Cancellation Reason*

Choose a reason for cancelling your membership.

If you are cancelling for monetary reasons, would you be interested in our Open Doors Financial Assistance program?

The Heart of the Valley YMCA is a 501(c)(3) nonprofit community organization with a charitable mission. Please indicate whether you would like to receive information about the Heart of the Valley YMCA financial assistance program.

Yes
No

Letter of Good Standing

If you are moving, please indicate whether you would like to receive a Letter of Good Standing to assist you in joining a YMCA in another city.

Yes
No

Acknowledgement of Termination of Membership*

It is my understanding that if I cancel by the 25th of the month, my membership will cancel at the end of that same month. If I cancel after the 25th, I will be drafted one more month and have full use of the facility in the last month that I am drafted. I am responsible for any past due balances and return/late fees associated with my account. By cancelling or allowing my membership to expire, I realize that my joining fee is non-transferable after 45 days.

Signature*

Termination of Membership Form

Termination of Membership Form