Individualized Guidance to Personal Fitness

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This nomination form is shared only with The Fort Madison Family YMCA management team and board of directors. Your nomination will remain a secret to the individual or family you nominate. If chosen you and your Nominee will be contacted and together you will have the opportunity to celebrate together when presentations of the memberships are awarded.

*You do not have to be a member to nominate
Please provide the nominee’s email address if known
Please list all phone numbers that we may reach the Nominee at using a comma to separate multiple numbers. Example: xxx-xxx-xxxx, xxx-xxx-xxxx
Please include full address of the nominee
Please list your nominee’s age or the number of people residing in the household of the Family you are nominating