Application for Membership

    List all participating family members: 
    For membership, annual dues are $20.00 per person or $30.00 per family and are payable to 140th New York. The Membership Committee reserves the right to request references.
    Return to:
    Susan Berardi 
    Secretary, 140th NYVILHO
    ​1175 Orchard View Dr. Apt 218
    ​Rochester, NY 14612
    email: [email protected]
    Supplemental Member Information:
    Please fill our this form as early as possible for entry into the unit database. Many events that we register for require information for emergency purposes. Having the information on file will facilitate the registration process. it will also be kept on hand in case of a medical emergency while at an event. parents, please fill out for each participating child as well. 

Printable Version

Membership Form
File Size: 55 kb
File Type: pdf
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For membership, annual dues are $15.00 per person or $25.00 per family and are payable to 140th New York. The Membership Committee reserves the right to request references.
Return to:
RuthAnn Williams
c/o 140th NYLHO
34 River Meadow Dr.
​Rochester, NY 14623-4813

140th NY VI

1335 Jefferson Road
Box 92494
​Rochester, NY 14692

Copyright 2017. 140th NY VI