NEW YORK WALKERS CLUB
membership application ($20.00)

new____renew____                                            NYWC#__________
                 
 
please print clearly in ink
     


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    last name                                                          first name

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    mailing address

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    city                                                      state                                    zip

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    home phone                    business phone                        cell phone

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    email address

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   male      female                                                 age                                  birth date

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    occupation                                                       employer

             
 
Yes, I accept your invitation to become a member of the New York Walkers Club. 
 
 
I understand that I am immediately eligible for all member benefits and that my membership
 
 
will help support the club's efforts to promote walking for fitness and for competition.
 
                 
 



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signature                                                                    date

 
                 
   make checks payable to:   New York Walkers Club
                                                     1020 Grand Concourse  Suite 15X
                                                      Bronx, New York 10451
   
email: wilson1947@verizon.net
   
phone: 718-588-0441