We are sad to see you go!

By completing this form, you are certifying that your membership meets one of the following criteria:

Membership was initially purchased online

Member has already relocated to a permanent residence more than 25 miles from our location (new address required)

For all other inquiries, please visit your branch to complete a Membership Cancellation Request Form.

In accordance with the provisions as set forth in my “Membership Agreement Pre-Authorized Monthly Bank/Credit Card Draft Plan,” let this serve as a request to initiate termination of my membership. I acknowledge that cancellation notification made less than thirty (30) days prior to the next regularly scheduled draft date, the 5th of the month, will not take effect until after the following month’s draft date. I understand that I am entitled to use membership or child care services until all drafted fees have been exhausted.

Name*
First Last
Email*
Phone
Locations*
By completing this form, I am certifying that I meet one of the following criteria*
- Membership was purchased online at tgfymca.org
- I have already moved more than 25 miles from this location
Provide New Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reason for Cancellation Request*
Comments
Signature*
Date*
Month
Day
Year

MM/DD/YYY

Membership Termination Request

We are sad to see you go!