Membership Removal Form

1
What is your primary membership branch?
Caldwell YMCA
Downtown Boise YMCA
Tomlinson South Meridian YMCA
West Boise YMCA
2
Primary members name:or secondary member over the age of 18
First Name
Last Name
3
Email address on file with the YMCA:
example@example.com
4
Street Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone number on file with the YMCA:
Area Code
Phone Number
6
What type of change would you like to make to your membership?
Remove individuals from my membership
Remove services (towels, Kid Zone, locker) from my membership
Remove both individuals & services from my membership
Other (please specify and a membership specialist will contact you shortly)
7
Please REMOVE the following individual from my account:All individual memberships are allowed only one (1) active member. 2-Person Family is defined as 2 adults in a domestic partnership OR 1 adult and 1 dependent child, age 23 or younger. Family membership is defined as 2 adults in a domestic partnership and their dependent children, age 23 or younger OR 1 adult and 2 or more dependent children, age 23 or younger.
First Name
Last Name
8
Age:
9
Gender:
Male
Female
Prefer not to say
10
Relationship to primary member:
11
Do you need to REMOVE another member?
YESNO
12
Please REMOVE the following individual from my account:
First Name
Last Name
13
Age:
14
Gender:
Male
Female
Prefer not to say
15
Relationship to primary member:
16
Do you need to REMOVE another member?
YESNO
17
Please REMOVE the following individual from my account:
First Name
Last Name
18
Age:
19
Gender:
Male
Female
Prefer not to say
20
Relationship to primary member:
21
Do you need to REMOVE another member?
YESNO
22
Please REMOVE the following individual from my account:
First Name
Last Name
23
Age:
24
Gender:
Male
Female
Prefer not to say
25
Relationship to primary member:
26
What services would you like to REMOVE from your membership?
Individual Towels @ $6/month
Family Towels @ $12/month
Locker Rental @ $15/month
Kid Zone for 1 Child @ $27/month
Kid Zone for 2+ Children @ $39/month
Monthly Personal Training (Must be approved by a Health & Well-Being staff member)
Monthly Donation
EGYM (South YMCA ONLY)
27
If removing Kid Zone, please specify the name, age & gender of each child you wish to remove (skip if not applicable):* Kid Zone is for youth ages 6 weeks through 6 years of age. For more information click here
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Other Changes: If you would like to request a change that was not included in this form, please specify below and a YMCA staff member will contact you shortly. If no further changes are requested, please click submit below.
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Ok
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All membership downgrades and removal of services will be effective on the first day of the month following receipt of this request. A YMCA staff member will reach out if the YMCA has additional questions.
I understand that changes will take effect on the first day of the next month.
30
SignatureBy signing below, I am authorizing the Treasure Valley Family YMCA to make all changes to my membership as outlined in this request form. I understand that all requested changes will be effective on the 1st day of the month following this request and I understand that they may change my monthly fee.
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