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Membership Application / Renewal / Support
Complete this form online, print it, and then mail or deliver it with your payment to the West 75th Street Block Association, 33 Riverside Drive, #2A, New York, NY 10023. (Checks payable to W75BA or to West 75th Street Block Association, please.)
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.
Name: _____________________________________
Address: ____________________________________
Phone: ______________________________________
E-mail:______________________________________I wish to make an additional contribution to the block beautification projects in the amount of: $____________
Amount enclosed: Cash: ________Check #_______Date:_______
Checks made out to the West 75th Street Block Association (or W75BA) may be dropped off or mailed toDee Rieber
33 Riverside Drive, #2A
New York, NY 10023Total Contribution: $ ____________________________
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Please check your specific areas of interest:
Beautification Projects
Block Safety
Political Action
Administration/Block Leadership
Membership DevelopmentAdditional Areas of interest/Concern: _________________________________________________________
___________________________________________________
Thank you !
