Membership Form

Please print and fill out the following form with payment. 

IMPORTANT: Please make check/money order payable to: Fund for the City of New York/DNNYC.  The Fund is our fiscal sponsor. 

Name:____________________________________________________________

Organization Name:____________________________________________________________

Street Address:____________________________________________________________

City, State, Zip:____________________________________________________________

Tel:_______________ (work); _______________ (home/cell) _______________ (TTY)

Fax:____________________________________________________________

E-mail:____________________________________________________________

Membership Category:____________________________________________________________

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

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