CBP Form

Welcome to Community-Based Pricing!

We’re here to help you find the right membership for you and your family. Fill out the form below to share a little about yourself, your household, and the type of membership you are interested in. Once submitted, one of our Membership Directors will reach out to guide you through the next steps, answer questions, and walk you through our Community-Based Pricing options.

To speed up the review process, you may upload your most recent 1040 and a month of pay stubs at the end of the form. This information helps us provide accurate rates and ensure every family receives the support they need.

Our team looks forward to connecting with you and welcoming you to the Y.

Primary Member's First Name

Primary Member's Last Name

Primary Member's Email Address

Primary Member's Phone Number

Number of People in Household

Annual Household Income

Membership Type

Preferred Branch

MacColl YMCA

32 Breakneck Hill Rd Lincoln, RI 02865

Pawtucket Family YMCA

20 Summer St Pawtucket, RI 02860

Proof of Income

If you would like, you can upload your most recent 1040 and a month's worth of pay stubs for all adults in the household here. You can also bring paper copies of them in person when you activate your membership.
Unlimited number of files can be uploaded to this field.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Community-Based Pricing Form

Welcome to Community-Based Pricing!