Mount Desert Island YMCA Membership Cancelation/Type Change Request Form

First name

Last name

Todays Date

Month

Day

Year

I would like to:

Cancel/ put my membership on hold

Change my membership type

I'd like membership cancelled effective (future dates only):

If you would like to change your membership type, what changes do you need?

By signing, I understand my membership, along with anyone in my membership unit, will be terminated.

If termination is requested before the end of the month, I will not be charged again. If termination is requested after membership dues have already been drafted for the month, membership is canceled for future months. Membership dues are not prorated. If I currently have a balance on my account, I will need to pay that balance to restart my membership or register for programs in the future.

Signature

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