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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