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: *

YMCA at Pabst Farms

Watertown Area YMCA

Have you been a member since January 1, 2020? *

Yes

Not yet

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)? *

Yes

No

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 *

Youth/Teen (0-19 years) $32/month for the first year	Young Adult (20-24 years) $44/month for the first year	Adult (25+ years) $66/month for the first year	Household* $93/month for the first year	Senior Adult (62+ years) $59.40/month for the first year
Senior Household** $83.70

Does your employer participate in our Corporate Membership program? *

Yes

No

I don't know

Please list your employer name here: *

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 *

Youth/Teen (0-19 years) $17/month for the first year	Young Adult (20-24 years) $22/month for the first year	Adult (25+ years) $43/month for the first year	Household* $62/month for the first year	Senior Adult (62+ years) $22/month for the first year
Senior Household** $33	Other

If none of these memberships types fit your needs, please identify the membership type you are interested in?

Please list the first name, last name and date of birth of the other members of your household?

+-

Please list the first name, last name and date of birth of the other members of your household?

+-

Would you like to pay for your membership as a monthly draft, or do you prefer to pay annually? *

Monthly draft from checking account

Annual payment

I'm not sure yet

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.

Bank Name: *

Account Number: *

Routing number: *

Would you like a New Member Wellness Center Orientation? *

Yes

No

I'm not sure I'm not sure

First Name *

Last Name *

Birthdate: * +

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Best method to contact you? *

Email

Phone

Promo code:

What size sweatshirt are you interested in? *

What color sweatshirt are you interested in? *

Additional notes/comments: