Membership Change Form

Please use the form below to make a change to your mailing address, membership type or if you want to change your auto pay method. Please note, you will need to log into your online account to add your new payment method. Go to My Account to log into or create your online account.

If you have any questions, please contact membership@fspymca.org.

Member Name: *

First

Last

Person Completing Form: *

First

Last

Phone *

Email *

Change of Address

New Address

Address Line 1

Address Line 2

City

State

Zip Code

Change Membership Type

Note: Changes to membership types must be made by the 25th of the prior month for the new rate to be effective for the next month's draft. For example, a change must be submitted by June 25 to be effective for July.

Change From:

to:

EXAMPLE: Change from Youth to Family

Which members would you like to remain active?

Please provide the name and birthdate of all members you would like to remain active:

Change Auto Pay

Please see instructions below

Other (Please specify)

If you want to use a credit card that is already on file, please provide the 4 digits of the card number:

Add new payment method:

To add a new payment method you will need to log in to your online account to add a new bank account or credit card. Go to fspymca.org/account and follow the instructions to set up or log into your account and change your payment method. If you have any questions, please email membership@fspymca.org

I understand that any changes to membership type must be made by the 25th of the month for the new rate to be effective for the next month's draft. I understand that if I selected "Change Auto Pay" that my credit card will be charged on the 1st of each month for the program selected except for Summer Camp, which will be charged on a weekly basis as outlined in our camp brochure. I understand that written notice is required if I need to withdraw my child from the program and/or cancel membership and that program/membership fees are non-refundable. Please sign by entering your name below: *

Today's Date: *

Phone