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Membership Change Form

Contact Information

Gender
Address

Change Membership Type

Must be completed by 15 days prior to the draft date

Add / Delete Household Members

Adult #2 plus any additional dependent children under the age of 24. Additional adults living in the same household over the age of 23 can be added for an additional $25 per month with proof of residency
Household Member
Add or Remove Household Member
Gender
Ethnic/Racial Background
Household Member 2
Add or Remove Household Member
Gender
Ethnic/Racial Background
Household Member 3
Add or Remove Household Member
Gender
Ethnic/Racial Background
Household Member 4
Add or Remove Household Member
Gender
Ethnic/Racial Background
Household Member 5
Add or Remove Household Member
Gender
Ethnic/Racial Background

New Account Type

Must be completed by 15 days prior to the draft date. Please be sure to Update Your Account with the new billing method.

Account Type
Change Draft Date
Prorated fees can be incurred.

Locker Rental

I would like to ...
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By submitting this form, I authorize the YMCA of Central Kentucky to make the changes listed above to my current membership. I authorize any changes in my bank draft amount that need to be made to coincide with the membership type I have chosen. If I choose to cancel my membership, I will notify the YMCA of Central Kentucky at least 15 business days prior to my draft date. Should my bank, for any reason, not honor my membership drafts, I understand that I am still responsible for that payment, plus any service charge applied by the YMCA.
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