Membership Form
Please print and fill out the following form:
Name:____________________________________________________________
Organization Name:____________________________________________________________
Street Address:____________________________________________________________
City, State, Zip:____________________________________________________________
Tel:_______________ (work); _______________ (home/cell) _______________ (TTY)
Fax:____________________________________________________________
E-mail:____________________________________________________________
Membership Category:____________________________________________________________
****IMPORTANT****
Please make checks payable to:
Fund for the City of New York/for DNNYC
Please mail your check and form to:
Rebecca Hinde, Director of Development
Disabilities Network of New York City
548 Broadway, 3rd floor, New York, NY 10012
T: 212-284-4160
F: 212-575-7669
E: rebecca@dnnyc.net
