Membership Form

Please print, fill out, and mail this form to:
West 80s Neighborhood Association, P.O. Box 732, New York, NY 10024
(Set your printer's margins to "0" if parts of this page are cut off.)
(You can also download a Microsoft Word version here.)

FIRST NAME:______________________ LAST NAME: ________________________________
FIRST NAME: ______________________ LAST NAME: ________________________________
ADDRESS: ____________________________________________________________________
CITY: ___________________________________________ STATE: _____ ZIP: _____________
PHONE: ___________________(hm) ______________________(wk) ____________________ (cell)
EMAIL: (please write legibly or use the boxes)
______________________________________________________________________________
____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|
Individual:  $ 25 ____           Dual:         $   40 ____        Family:  $ 50 _____
Business:  $ 75 _____         Building:   $ 500 ____        Other:     $ ________

 Questions: info@west80s.org
 Website:    www.west80s.org