HomeMy WebLinkAboutMembership Hold FormO'Brien / YMCA Partnership
Membership Hold Form
Contact Information for Duration of Hold Status
Permanent address Temporary address - travel/seasonal holds
Primary Member
Address
City State Zip
Email Phone
Hold Start Month Next Billing Month (resumes)
Is your hold due to medical reasons?
Yes - please attach proof No
Signature Date
Please note: All changes must be made before the 1st of the month.
Desk Staff Initial Member ID Final Draft OFFICE USE ONLY
I acknowledge that:
Minimum hold time is 1 month
Memberships put on hold will be drafted $10/month
Hold for seniors (65+) and for medical reasons will not be charged a monthly hold fee
Membership Hold Policy: We will draft $10 a month while your membership is on hold. Exceptions are for
seniors (65+) and those with medical reasons. If your membership is terminated you will be subject to a join fee.
Hold status will go into effect on the first of the next month.
Date: