Organizational Membership Application

Join PHANYC and help improve the condition of public health in New York City!

If you are an individual, please use our Individual Membership Application.

If you would prefer to mail this form, please download and print this PDF.

Contact Information
Organizaton*
Contact Name*
FirstLast
Address
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Work Phone*
Fax
Email*
Website
Membership Information
Type of Application
- New
- Renewal
Product Name
Additional Donation
Total
$0.00
Payment Information
PHANYC accepts checks made out to PHANYC, or credit card payments through PayPal. If you pay by check, please forward your payment to PHANYC, 1710 First Avenue, Suite 282, New York, NY 10128.
For credit card payment, you will be asked to enter your credit card information using our secure online bill pay form through PayPal.
Note: Your membership will not be active until your payment is received.
Payment Method
- Check
- Credit Card / Paypal
Please make checks payable to PHANYC.
Mail to:
Public Health Association of New York City
1710 First Avenue
Suite 282
New York, NY 10128
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