Harlem Kensington Cleveland Community Association

Membership Form

Name______________________________________________________________

Address_______________________________________________ Zip __________

Phone _____________ Email Address __________________________________

Please PRINT out and complete this form and bring it to the next meeting or

send with check for $15 to:

HKCCA

3908 Harlem Road #230

Amherst, NY 14226-4702

You will get your Membership Card in the mail in about a week!