
MEMBERSHIP CANCELLATION REQUEST FORM
(All applicable information must be filled out for this request to be processed)
___________________________________________ ________________ _____________
Last Name First Name Middle Initial Membership Type Date
______________________________________________ ___________________________________ ________ ____________
Mailing Address City State Zip Code
_____________ ______________________ ____________________________________ Draft ___ Payroll ___ Full Pay_____
Birthdate Phone E-Mail Address
________________________________________ ________________________________________
(Is this a Corporate membership?) Employer
If Youth Membership, Parent or Guardian Name
To help us ensure future quality at our YMCA, please answer the following questions:
• Which of the following best describes your reason for requesting this cancellation?
Transfer to another YMCA _____________________ Not Using
Relocating –Where? ____________________________ Purchased own equipment
Joined another fitness center – Please name other facility ____________________
Too expensive / financial reasons. Would you be interested in receiving information on our Financial Assistance
membership program? YES NO
Other – Please tell us why:_________________________________________________________
• What was the # 1 reason you joined our YMCA?
• What did you DISLIKE about this YMCA membership?
• How likely are you to rejoin the YMCA?
• Do you have any suggestions to help us improve our facility or programming?
I understand I(we) must be a member for the duration of any programming and I will be billed for the Non-Member rate of any
programs I(we) am(are) registered for.
I understand that I must cancel my membership in writing 30 days prior to my next payment. Refunds are not given for failure to
give the YMCA timely notice. If I wish to join the YMCA again, and more than 30 days passed since my last active membership, I
understand I will be required to pay a new association fee.
Member Signature____________________________________________________________ Date:____/____/______
THE MANKATO FAMILY YMCA TRANSFER LETTER OF GOOD STANDING
This letter is to confirm that _______________________________________has been a member in good standing at the
Mankato Family YMCA since _____/_______/________. Date of last payment_____/_______/__________.
If you have any questions, please call us at 507-387-8255.
FT ID#_________________________
Membership Begin Date:___________
Last Draft Date:__________________
Date to Cancel:___________________
Staff Initials:_____________________
1401 South Riverfront Drive
Mankato, MN 56001
(507)387-8255
www.mankatoymca.org
Please rate each of category on a scale of 1-5, with 5 being excellent:
Cleanliness of facility _____Staff friendliness
_____ Information availability _____ Equipment / maintenance
_____ Staff knowledge _____ Overall membership value
_____ Quality / variety of programs _____ Hours of operation
_____ Facility security / safety