NO REINSTATEMENT FEE YMA SPECIAL!

Thursday, July 20, 2017

TIME LEFT: 8 hours 27 minutes 19 seconds

SPECIAL ENDS JULY 15TH AT 11:59PM 2014 OR WHEN PROGRAM FILLS!

IF YOU USE THIS FORM AFTER JULY 15TH THERE WILL BE A $75 REINSTATEMENT FEE.

**IMPORTANT! YOU WILL RECEIVE A CONFIRMATION EMAIL AFTER THE PROCESS IS COMPLETE. IF YOU DO NOT RECEIVE AN EMAIL, YOU DID NOT SUBMIT THE FORM CORRECTLY.**

Students Name (First, Last): (required)

Parent/Account Holder's Name (First, Last): (required)

Your Email: (required)

My child was in a:

I would like my child to be in:
at
and
at

Account you wish to use for payment:

Type of Account:
Name on Account:
Last 4 Digits of Account/Card Number:
**Name & Last 4 Digits not needed if "Current Account on File" is chosen.**
**The initial charge will be put on the account we have on file already unless that account payment fails. If the payment fails we will then need to put it on a new account provided by the account holder above.**

I UNDERSTAND (required):

1. All memberships require 31 days written notice to cancel and your payments will stop after the next billing cycle. It is a minimum of two full paying months payment, paid for by the month. This does not include any payment for a special or promotion if it is not a full month's payment.

2. By checking the following box I understand and agree to the Membership Policies and have read the FAQ regarding our rules, payments, cancellations, holds, etc.

3. I agree and confirm that I am 18 years or older and if I am not the student who this addition is concerning, I confirm that I am the parent or legal guardian of the above student.

4. I understand that if I am reactivating an account on hold there will be NO ADDITIONAL FEE for reactivating. However, if I am reinstating an account which was previously canceled I was granted the membership without a start-up fee and I was able to cancel without a cancellation fee. That said, I agree and understand that my account will incur a reinstatement fee of $75.

I UNDERSTAND AND AGREE TO ALL OF THE ABOVE:

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