WSNA Annual Membership Form

Please ( ) enroll ( ) renew the following as members of the West Side
Neighborhood Association of Binghamton, NY, Inc. and put them on the
mailing and e-mail lists:

Name(s)_______________________________________________________________

Street Address____________________________________Binghamton, NY 13905

Telephone number(s)___________________________________________________

E-mail address(es)____________________________________________________

Gold member          $100.00 ___
Sustaining member     $50.00 ___
Business member       $50.00 ___
Family member         $20.00 ___
Individual member     $10.00 ___
Special circumstances  $5.00 ___

I/We are interested in serving on the following committee(s):

Historic Preservation ( ), Newsletter ( ), Planning and Economic
Development ( ), Social and Community Events ( ), Zoning and Code 
Enforcement ( ), Hospitality ( ), Trees ( )

Please make check payable to WSNA, Inc.
Send to WSNA, Inc., P.O. Box 233, Binghamton, NY 13905