Modify Your Membership

Modify Membership Contact Forms

Enter all required information and select your home branch. Fill out the appropriate form based on your request.

First Name

Last Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of Birth xx/xx/xxxx

Your YMCA Branch

Butler YMCA

Rose E. Schneider Family YMCA

I would like to...

Hold my membership

Members may hold their membership for 2 consecutive months without paying dues.

Change my membership

Change your current membership type to a different one,.

Cancel my membership

Cancel your current membership.

Hold Membership Form

First Month of Hold

Second Month of Hold (optional/max 2 months. Must be consecutive)

What is the reason for your Hold request?

Please read each statement below, then select each checkbox as receipt of acknowledgement.

A membership hold is temporary. Membership will continue monthly payments at the end of this hold.

I understand I will be charged one more month, prior to hold, if seven-day notice prior to billing date is not provided.

Family members may not be registered in programs that run during membership hold. Account will be charged non-member price rate for program if membership hold is submitted.

Change Membership Form

Current Membership Type

Change Membership Type to

Current Membership Type

Change Membership Type to

Member(s) to remain active

Would you like to add additional member(s) to your account?

Yes

Please add all NEW members who are not currently on your membership account. First & Last name and Birthdate are required for all.

New Member # 1

First & Last Name

Date of Birth

New Member # 2

First & Last Name

Date of Birth

New Member # 3

First & Last Name

Date of Birth

New Member # 4

First & Last Name

Date of Birth

By checking the box of each statement below, you understand that:

1.) All members must be living at this address; Children must be UNDER the age of 26 on a family membership; Children must be ages 3-17 or still in high school to hold a youth membership.

2.) Membership may not be changed if member(s) being made inactive is/are currently registered in a program.

3.) I will be charged one more month at the current membership rate if a seven-day notice prior to my billing date is not being provided.

4.) This change will be immediate and may incur a prorated membership dues fee based on new membership type and my next monthly membership dues billing date.

5.) This change may incur a join fee if upgrading to a membership that is applicable to a join fee and the YMCA join fee policy.

Cancel Membership Form

Did you know you can Hold your membership for up to 2 months without paying membership dues? Just select "Change my Membership" under the "I would like to..." section.

Reason for canceling your membership

What YMCA are you switching to?

Did you know you can Hold your membership?

You can Hold your membership for up to 2 months without paying membership dues! If you cancel, you may need to repay the Join Fee when you return. Scroll up and select "Hold my Membership" to continue.

We offer financial scholarships!

Before you go, we'd like to invite you to apply for our scholarship program. Members who qualify can receive discounts on membership dues and programs. Fill out the form by going here: ADD FORM

Please read each statement below, then select each checkbox as receipt of acknowledgement.

Billing will be charged one more month if a seven-day notice prior to billing date is not provided. Billing may be updated by calling the membership service desk, (Rose YMCA) 724-452-9122 or (Butler YMCA) 724-287-4733.

Family members may not be registered in programs that run after membership termination.

Account will be charged non-member rate for program if membership termination is submitted. Request membership type change appropriate to family member in program by emailing rosebilling@bcfymca.org. Request requires seven-day notice prior to billing date. You MUST receive a confirmation to ensure your request was received.

Memberships inactive longer than two months will be recharged the Join Fee.

Signature

Please authorize this submission with your signature.

CAPTCHA

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