Fair Acres Family Membership Application Form Page 2
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1
2PAYMENT AGREEMENT
Monthly Bank Draft (EFT) or Credit Card Payment Plan
I agree to the following:
th
1.
First month’s dues just be paid at time of application and will be prorated to the 14
of the month
2.
Bank draft (EFT) or Credit Card membership is a continuous, ongoing membership until the YMCA receives proper cancellation
notice.
st
3.
EFT or Credit Card memberships can be cancelled with a 30-day written notice before the 1
of the month. Membership cards must
be turned in at the time of membership cancellation.
4.
Member agrees to monitor personal bank account to make sure sufficient funds are available to meet monthly ayment obligation,
and, in event he/she terminates membership, will monitor account to make sure payments are stopped as per cancellation agreement.
5.
YMCA reserves right to cancel my membership due to two (2) months of insufficient or a stop payment. If this should occur, the
EFT or Credit Card membership plan may no longer be available to me.
6.
YMCA reserves right to make any necessary rate adjustments at any given time. If this should occur, the YMCA will issue proper
notification.
7.
There will be a $25 charge for each insufficient funds, closed accounts or late payments.
8.
There will be no refund of membership dues already paid.
st
th
9.
Membership dues are due on the 1
of the month. Membership dues will be drafted on the 15
of each month.
__________________________________________________________________________
Signature of Applicant or Guardian
Date
Annual and Semi-Annual Payment Plan
I agree to the following:
1.
Dues will be paid in full annually or semi-annually.
2.
Full payment annual dues must be paid at the time of application.
3.
If the membership is cancelled or allowed to lapse more than 30 days, the joiner fee must be paid to reinstate my membership.
4.
There will be a $15 charge for late payment of dues.
5.
I understand that my membership can be cancelled with a 30 days written notice and all membership cards returned to the Fair
Acres Family YMCA.
6.
There will be no refund of membership dues already paid.
____________________________________________________________________________
Signature of Applicant or Guardian
Date
How did you hear about YMCA?
____ Radio/TV
____ Was a member of another Y
____ Dr. Referral
____ Newspaper
____ Other Member
____ Other
What types of programs are you interested in?
____ Aquatics
____ Aerobics
____ Fitness
____ Racquetball
____ Youth Sports
____ Adult Sports
____ Sr. Programs
____ School-age Child Care/ Summer Camp
____ I would like a FREE fitness orientation to help me get started in an exercise program.
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