YMCA Kirkham - Fylde Coast YMCA Y:Active

Name*
Forename Surname
Membership ID (if known)
Membership Card Number (if known - usually starts with LS..)
Address*
Street Address Town Post Code
Phone Number*

If landline number, please include STD code. We could us this contact number to contact you about your request.
Email*
Enter Email Confirm Email

We could also use this email to contact you about your request.
Bank Account Number*
Sort Code*
By ticking the box above you agree that you would like a pro rata refund of your membership. We will be in touch after our checks to obtain more details in order to process this. Most payments will be made by BACS straight into your account, so we will be in touch to obtain more details regarding this. By receiving a pro rata refund you agree that your membership will be cancelled. Please tick the box above to agree and continue.*

By ticking the box above you agree that you would like a pro rata refund of your membership. We will be in touch after our checks to obtain more details in order to process this. Most payments will be made by BACS straight into your account, so we will be in touch to obtain more details regarding this.

By receiving a pro rata refund you agree that your membership will be cancelled.

Please tick the box above to agree and continue.
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