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:______________________________________

Individual: $15
Family: $25
Merchant Sponsor: $50
Building Sponsor: $100

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 to

Dee Rieber
33 Riverside Drive, #2A
New York, NY 10023

Total Contribution: $ ____________________________

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Please check your specific areas of interest:

Beautification  Projects
Block Safety
Political Action
Administration/Block Leadership
Membership Development

Additional Areas of interest/Concern: _________________________________________________________

___________________________________________________

Thank you !