Complete this form online, print it, and then mail or deliver it to the West 75th Street Block Association,33 Riverside Drive, #2A, New York, NY 10023.

The Association is incorporated under section 402 of the not-for-profit corporation law of New York and is run by a volunteer leadership committee.

Membership Application

West 75th Street Block Association
33 Riverside Drive, #2Am New York, NY 10023
E-mail: info@w75ba.org

Membership dues:

Individual $15/yr. Family $25/yr. Merchant $50/yr.

I would also like to donate $ to the block association.

Total enclosed $

* Denotes required field. Although not required, if you choose to provide e-mail, cell, and fax numbers, we will keep your information confidential and it will enable us to contact you directly and more efficiently with association announcements, newsletters, and emergency information.

Name*

Business Name
(for merchant members)

Address*

Phone* Cell Fax

E-mail

Your interests & concerns

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