Membership Hold Request
Select Your Branch
(Required)
Downtown YMCA
Eastside YMCA
Glenwood Park YMCA
County YMCA
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Reason for Hold
(Required)
Medical
Vacation
Work
Payment Issue
Leave of Absence
Other
Please
Click Here
For Information on Financial Assistance
If other, please explain:
(Required)
Hold Start Date:
(Required)
MM slash DD slash YYYY
Hold End Date:
(Required)
MM slash DD slash YYYY
I understand that my membership can be placed on hold a maximum of three months in one calendar year.
(Required)
Holds must be requested prior to the absence and in order to stop the automatic withdrawal for the time requested. Holds are limited to 90 days in a calendar year and are not required to be taken consecutively. The annual maintenance fee will be processed even if your circle is on hold at the time. I understand it is my responsibility to inform all members in my circle that the membership is being deactivated during this timeframe and members will not have access to the Y. The circle will be automatically reactivated at the date(s) requested and the circle will be billed upon reactivation.
I agree to the terms and conditions.
Would you like to learn how you can DONATE your membership dues?
(Required)
Not ready to return to the Y, but still want to support the great work we do for the community? Our team can easily convert your monthly membership dues into a tax-deductible donation. Learn more and stay with us!
Yes, contact me
No, please place me on hold