New Member Interest Form

We're so glad you are interested in starting a new membership. Please review the following information and provide the requested demographic information.
Select your home branch: *
Have you been a member since January 1, 2020? *
Has any of your demographic or household member information changed since your membership was last active (i.e. address changes, young adults who are no longer in the household, birth of a new child)? *
What membership type are you interested in?
.*Household membership includes one or two adults and their dependents (children under age 24 if full-time students), all residing in the same household.
.** Senior Household: Both individuals residing at the same address must be 62+ years old to qualify for a Senior Household membership *
Does your employer participate in our Corporate Membership program? *
Partnering employers provide an investment toward the membership that the Y matches. Our Membership team will confirm your employee rate before your membership starts. 
 
You will be asked to provide proof of employement to acess your employer rate. Employement verification is initiated by the Y on a regular basis. 
What membership type are you interested in?
.*Household membership includes one or two adults and their dependents (children under age 24 if full-time students), all residing in the same household.
.** Senior Household: Both individuals residing at the same address must be 62+ years old to qualify for a Senior Household membership *
Please list the first name, last name and date of birth of the other members of your household?
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Please list the first name, last name and date of birth of the other members of your household?
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Would you like to pay for your membership as a monthly draft, or do you prefer to pay annually? *
In order to start a monthly bank draft for your membership, we need to collect your banking information. If you choose not to provide it here, we will call to collect this information allong with prorated dues within 3 business days of completing this form. 
Would you like a New Member Wellness Center Orientation? *
 
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Best method to contact you? *