Membership Hold Request Form - South Shore YMCA

Thank you for being part of the South Shore YMCA. If you wish to help support the Y even if you aren’t able to come to the Y, please consider donating your membership dues! Visit our Meaningful Membership donation page for details.

South Shore YMCA Membership Hold Request

Submit this form if you wish to place your South Shore YMCA membership and payments on hold for up to 4 months. Our team will contact you to confirm your request within 1-3 business days.

Name*
First Last
YMCA Branch*
Today's Date*
Date Format: MM slash DD slash YYYY
Requested "Hold Until" Month/Year*
When would you like to resume your monthly membership? Note, holds are typically accepted for 1-4 months.
Member ID# / Member Tag #
Help us identify you in our system with your Y tag # or your membership ID#.
Date of Birth*
MM
DD
YYYY
Home/Primary Phone*
Mobile Phone
Email*
Monthly Draft Date*
The day of the month that your membership dues are drafted from your bank or credit card account. Typically 1st or 15th of the month.
- 1st of the Month (first)
- 15th of the Month (fifteenth)
- I don't know
- This is an annual membership - paid in full
Primary Reason for Hold*
Choose one. Please note that Medical, Military and Temporary Residence holds will require additional documentation.
Comments / Questions
Would you like to learn how you can DONATE your membership dues?*
Not ready to return to the Y, but still want to support the great work we do for the community? Our team can easily convert your monthly membership dues into a tax-deductible donation. Learn more and stay with us!
- Yes, contact me
- No, please place me on hold