Member Reactivation Please let us know your plans for returning to the Y by June 30 Member Reactivation Form Name* First Last What would you like to enter?* Birth Date Member ID Number Birth Date* Month Day Year Member ID Number* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Please tell us your reactivation plans:* I can’t wait to come back to the Y! Please reactivate my membership immediately. I understand I will be charged for a prorated portion of June as appropriate. I will be back in August and agree to be charged on August 10. I will be back in September and agree to be charged on September 10. I will not be returning to the Y by one of these dates. I understand that by selecting this option, I will be forfeiting my locker and/or laundry bag. If I do not come to the Y by June 30 to empty my locker and/or laundry bag, my locker will be reassigned and any belongings donated or disposed of. CAPTCHA If you have questions about your membership, please contact Lauren Frazier, Assistant Director of Member Services, at 908-301-YMCA (9622) or firstname.lastname@example.org.