Campanelli Ymca Membership Cancellation Form
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1Campanelli YMCA
Membership Cancellation
Name:________________________________________________________________________________________________________________________________________
Address:_______________________________________________________________City:________________________________________________________________
State:________________________________ Zip:____________________________ Phone:_____________________________________________________________
I would like to cancel my membership for the following reasons:
__________Moving (02)
__________Illness (03)
__________Dissatisfied with Facility (04)
__________Joined Another Club (05)
__________Can’t Find Time (06)
__________Financial Reasons (07)
__________Dissatisfied with Programs (08)
__________Drop for Summer/Winter (09)
__________Leaving for School (10)
__________Lost Motivation (11)
__________Other (12) / Please Specify Reason:____________________________________________________________________________________________
Please help us improve our service by completing this brief survey:
Excellent
Good
Average
Fair
Poor
Cleanliness of Facility
5
4
3
2
1
Friendliness of Staff
5
4
3
2
1
Quality of Programs
5
4
3
2
1
Do you feel well informed on all activities available to you at the YMCA?
Yes
No
Do you feel we helped you reach your fitness goals?
Yes
No
If no, did you discuss your goals with a staff member?
Yes
No
Would you recommend the Y to a friend, co-worker, or relative?
Yes
No
Is there anything we can do to help you remain a satisfied member? ______________________________________________________________________
_____________________________________________________________________________________________________________________________ _________________________________
I am requesting that the Campanelli YMCA discontinue my membership. I understand this form will serve as my 15 day
written notice needed to CANCEL my membership draft. I also certify that I have received a copy of this form.
FINAL DRAFT DATE:______________________________________________
MEMBER SIGNATURE:____________________________________________________________________________________________________________ ________________________
Staff Initials:__________________________________ Date:__________________________________
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Parent category: Business