Employee Membership Application

Welcome to the YMCA! Please complete the form below to receive your complimentary employee membership.

Primary Member Information
Title (Mr., Mrs., Dr., etc.)
First Name
Middle Initial
Last Name
YMCA Job Title
Gender Identity
If you have an additional gender identity and would like to share that identity with us, please specify below:
Race
Birthday

Contact Information
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Would you like to opt in to receive text messages about facility closures, reminders, and other updates? Message and data rates may apply. Message frequency varies. Text HELP for help. Text STOP to cancel.
Email Address

Preferred Branch
Please select your preferred membership branch:

Status of Employment with the YMCA
Please select your status of employment with the YMCA:

Household Members

Full-time and part-time plus employee benefits include a household membership at no additional cost. Part-time employee benefits include an individual membership, however part-time employees are welcome to upgrade their memberships to include household members by stopping by the front desk at one of our membership branches.

If you would like a household membership, whether it is included in your benefits or if you are planning to upgrade your membership, please list your household members' names, birthdays, and genders below. Include both first and last names of each member. Please separate name, birthday, and gender with commas.
Household Member 1: Name, Birthday (MM/DD/YYYY), and Gender
Household Member 2: Name, Birthday (MM/DD/YYYY), and Gender
Household Member 3: Name, Birthday (MM/DD/YYYY), and Gender
Household Member 4: Name, Birthday (MM/DD/YYYY), and Gender
Household Member 5: Name, Birthday (MM/DD/YYYY), and Gender

Emergency Contact
Name of Emergency Contact
Phone Number of Emergency Contact

Areas of Interest
We are dedicated to customizing your YMCA experience. Please take a moment to list your interests so we may better serve you and your family.
Are you interested in becoming a volunteer?