YMCA of Metropolitan Washington Leave of Absence Request

Thank you for your YMCA membership. After you have successfully completed this leave of absence request form, your membership will be placed on hold for the length of time you selected in accordance with the policies outlined in the membership handbook (https://www.ymcadc.org/membership-handbook/). Please note that membership payments will automatically resume once your selected hold period has ended. If you have any questions, please email member.service@ymcadc.org.

Question Title

* 1. Please provide your name and contact information. Your YMCA member identification number can be found on the back of your membership identification card.

Name *

YMCA Member ID #

Address

Address 2

City/Town

State/Province

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Please select your home YMCA branch location.

YMCA Alexandria

YMCA Anthony Bowen

YMCA Arlington

YMCA Bethesda Chevy-Chase

YMCA Fairfax County Reston

YMCA SIlver Spring

Question Title

* 3. What is the reason you would like to place your YMCA membership on hold?

I am leaving the area and unable to visit a Y where I am going.

I am not able to use my membership for a brief period of time.

I request a military leave of absence for a temporary assignment.

I request a medical leave of absence for medical/health-related reason(s).