Membership Form
Amount of check: ________ (suggested dues $40 quarterly, $175 per year for block residents, $87.50 per year for off-block residents)
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:
Mary Jo Gennaro
315 Riverside Drive, Apt 7C,
New York, NY 10025
Or drop off at one of our member buildings.
895 West End Avenue: Grannis, Apt 8B
320 Riverside Drive: Waskow, Apt 8G
315 Riverside Drive: De Gennaro, Apt 7C
309 West 104th Street: Mann, Apt 3A