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:_______________________________________________

Category:_____________________________________________

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

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