Request Account Change - The YMCA of Greater Birmingham: For A Better Us

Name*
First Name *
Name*
Last Name *
Email Address*
Confirm Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
Home branch*
What would you like to do?*
- 1-REACTIVATE Membership
- 2-Upgrade Membership (add dependents/household members)
- 3-Downgrade Membership (remove dependents/household members)
- 4-Cancel Membership (30 day notice - may return in 6 months w/ no Activation Fee)
- 5-Request a Childcare or Program adjustment (fill out details at bottom of this form)
- 6-Other (specify below)
1-If you had an active Y membership in the past 6 months, we can reactivate the membership for you. Please include the Membership Type and Names/DOB of household members you would like to reactivate. If outside of 6 months, please complete the On Line Join process found at the top of our website.
2-If Upgrading your membership, please list DOB and name(s) of Household Member(s) you would like to add
3-If Downgrading your membership, please list DOB and name(s) of Household Member(s) you would like to remove from your account
4-If canceling your membership, what is your reason for cancellation? (this will serve as your 30 day written notice)
5-How may we assist you regarding your childcare/ program account?
6-If you have another request not listed, how can we assist?

Request
Account
Changes