Please take a moment to fill out the form below and consider becoming a member at the level that is most comfortable for you.

To join the Neighborhood Network

print this page, fill out the form, and mail it with your contribution

to the address at the bottom of the page. Here is my contribution to support the Neighborhood Network's efforts to reduce pesticide use, protect open space and drinking water, and seek more responsive federal, state and local governments.

Check One

__$40	Basic membership
__$60	Family membership
__$120	Friend of the L.I. Neighborhood Network
__$250	Sponsor
__$20	Student & low income membership
__ Other	$____

Name____________________________

Address_____________________________________

Phone_______________

Method of Payment:

__Check

__Visa

__MC

__Amex

__Disc

Card #_______________________ Exp. Date___________

Signature_______________________

Please make checks payable to: Neighborhood Network.

Mail to:

Neighborhood Network

7180 Republic Airport
East Farmingdale, NY 11735