TYPE OF MEMBERSHIP:

FAMILY - 2 adults and children 18 and under who live in the household

ADULT - age 19+ if not in college

HIGH SCHOOL - grades 9th through 12th

SENIOR - age 65+

YOUTH - ages up to 8th grade

COLLEGE - full-time students must show I.D.

SINGLE PARENT - 1 adult and children 18 and under who live in the household

Join the Y

Please select your membership type:
Select Membership
*One-time fee as long as membership is kept current
 
Family Members:
Name Date of Birth
Name Date of Birth
Name Date of Birth
Name Date of Birth
Name Date of Birth
 
Credit Card Information:
Credit Card Type
Credit Card Number
Expiration Date
CVV
 
Billing Information:
Name on Card
Address
City
State
Zip
Phone Number
Email

In consideration of the acceptance of my membership at the Greater Carbondale YMCA, I (and my family if family membership), the undersigned, intend to legally bound hereby, waive and release for myself, my heirs, executors and administrators any and all rights and claims for damages, demands and actions whatsoever, including negligence, which I or my family may have against the Greater Carbondale YMCA, all sponsors, all participating volunteers and supporters and those entities, representatives, successors and assigns, arising out of this membership, including any and all injuries suffered.

I have read the Membership Policy, Member Code of Conduct, Cancellation Policy, and Photo Waiver

Greater Carbondale YMCA Debit/Credit Authorization
Payment will be drafted on the first of the month for Membership.
I/we hereby authorize the Greater Carbondale YMCA to initiate debit/credit entries to my/our credit card account indicated below, and if necessary, initiate adjustments for any transactions credited/debited in error.  I/we acknowledge that the origination of the ACH transactions to my/our account(s) must comply with the provisions of the U.S. law.
This authority will remain in effect until the Greater Carbondale YMCA receives a cancellation form.  The notice of cancellation must be in writing and received one month prior to the requested termination date in order to give the YMCA and the bank ample time to stop the upcoming transaction.

Greater Carbondale YMCA Bank Draft Refund Policy
After giving 30 days written notice to cancel a monthly bank draft, either for membership and/or program dues, there will be a 60-day grace period for the refund of extra drafts, if applicable.
It is the responsibility of the member or program participant to notify the YMCA, within 60 days of cancellation, if the draft is continuing to be withdrawn from their account.  The YMCA is not responsible for refund of payments withheld after this 60 day period.  The member or program participant is advised to keep a copy of the written cancellation notice as proof of bank draft cancellation.
It is the responsibility of the member or program participant to check account statements to verify draft cancellation and notify the YMCA within 60 days of cancellation, if the draft is continuing.

You will receive notice prior to any yearly nominal rate increases.

I have read the above statements on Debit/Credit Authorization and Bank Draft Refunds.  Furthermore, I understand and agree to this policy.

 

Electronic Signature: