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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:
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YMCA at Pabst Farms
Watertown Area YMCA
Have you been a member since January 1, 2020?
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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)?
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Yes
No
What membership type are you interested in?
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*Household membership includes one or two adults and their dependents (children under age 24 if full-time students), all residing in the same household.
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** Senior Household: Both individuals residing at the same address must be 62+ years old to qualify for a Senior Household membership
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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?
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Yes
No
I don't know
Please list your employer name here:
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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?
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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?
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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:
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Account Number:
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Routing number:
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Would you like a New Member Wellness Center Orientation?
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Yes
No
I'm not sure
I'm not sure
First Name
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Last Name
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Birthdate:
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Street Address
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Address Line 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Email Address
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Best method to contact you?
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Email
Phone
Promo code:
What size sweatshirt are you interested in?
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Small
Medium
Large
X Large
XX Large
What color sweatshirt are you interested in?
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Heather Kelly Green
Heather Navy Blue
Heather Royal Blue
Black Camo
Mint
Additional notes/comments: