Join the West 104th Street Block Association

Membership Form

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Amount of check: ________ (suggested dues $40 quarterly, $160 per year)

Please allocate my contribution to:

___ Security

___ Beautification

___ Social

___ Newsletter

___ Board decision

Name ______________________________________________________________________

Address ________________________________________________ Apt Number ________

Email Address _______________________________________________________________

Phone ______________________________________________________________________

Suggestions for the block: ____________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Make checks payable to “West 104th Street Block Association”

Mail to our Treasurer:

Barbara Boynton
905 West End Avenue, Apt #71
New York, NY 10025

Or drop off at one of our member buildings.

308 West 104th Street: Grace, Apt 1A
895 West End Avenue: Hertzfeld, Apt 5D
320 Riverside Drive: Waskow, Apt 8G
315 Riverside Drive: Howitt, Apt 8C
309 West 104th Street: Mann, Apt 3A

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