Membership Cancellation Request

Please complete the following form to cancel your membership. The West Suburban YMCA requires a written notice of termination at least 15 days before the next automatic draft date to prevent further billing. After your final draft, your membership privileges will expire on the 14th of the following month. Members can cancel their membership at any time, and there is no cancellation fee. If you'd prefer to freeze your membership for up to four months, please fill out the Freeze Request Form.

Membership Cancellation Request

First Name

Last Name

Date of Birth

Email

Phone

Membership Type

Home Branch

Reason for Cancelling

Your Current Donations

Some members make a donation in addition to their monthly dues. If you already make a donation, would you like to continue or freeze this with your membership?

Make a One-Time Donation

Would you like to make a one-time donationt to the Y? Please indicate how much you would like to donate.

Electronic Member Signature

Sign above

CAPTCHA

Math question 8 + 12 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Type Member Name