Serving Rye, Rye Brook, Rye Neck,
Harrison, Purchase and Port Chester



     



MEMBERSHIP FORM
COPY AND PASTE
INTO EMAIL OR WORD
THEN
PRINT AND SEND TO ADDRESS BELOW

     
RENEWAL                        NEW MEMBER

     

Date:                                _______________________________________________

Last Name                        _______________________________________________

First Name                        _______________________________________________

Spouse’s Name                _______________________________________________

Address                        _______________________________________________

City and Zip              _______________________________________________

Telephone                        _______________________________________________

Email                                _______________________________________________

Children’s Names/Ages        _______________________________________________


PLEASE MAIL YOUR $40 CHECK MADE PAYABLE TO

The Rye Newcomers & Neighbors' Club AND
THIS FORM TO:
A.  VAN WEERELT @ 47 BEVERLY DRIVE, RYE, NY 10580

Please do not write below this line
--------------------------------------------------------------------------------------------------------------------

Date Received                        ______________________

Check enclosed                      ______________________

                                      Date entered                        ______________________