MANKATO FAMILY YMCA 1401 South Riverfront Drive Mankato, MN 56001 (507)387-8255 www.mankatoymca.org
MEMBERSHIP CANCELLATION REQUEST FORM
(All applicable information must be filled out for this request to be processed)
Staff Use ONLY
FT ID#_________________________
Membership Begin Date:___________
Last Draft Date:__________________
Date to Cancel:___________________
Staff Initials:_____________________
Copies: Admin Marketing Membership Member
___________________________________________ |
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_____________ |
Last Name |
First Name |
Middle Initial |
Membership Type |
Date |
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______________________________________________ ___________________________________ |
________ |
____________ |
Mailing Address |
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City |
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State |
Zip Code |
_____________ |
______________________ |
____________________________________ |
Draft ___ |
Payroll ___ Full Pay_____ |
Birthdate |
Phone |
E-Mail Address |
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Payment Method |
________________________________________ |
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________________________________________ |
(Is this a Corporate membership?) Employer |
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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?
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Transfer to another YMCA _____________________ |
Not Using |
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Relocating –Where? ____________________________ |
Purchased own equipment |
Joined another fitness center – Please name other facility ____________________
Too expensive / financial reasons. Would you be interested in receiving information on our Financial Assistance membership program? YES NO
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 |
_____ Overall membership value |
_____ Quality / variety of programs |
_____ Hours of operation |
_____ Facility security / safety |
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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.
I understand that I must cancel my membership in writing 30 days prior to my next payment. 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_____/_______/__________.
If you have any questions, please call us at 507-387-8255.