Rochester NOW Membership Form
Print the form below, complete and mail with check payable to Rochester NOW to:

Rochester NOW
P.O. Box 93196
Rochester, NY  14692
Attn:  Membership Chair

Name:  ______________________________________________

Address:  ____________________________________________

City:  ________________________ State: ___  Zip: _________

Phone:  (_____) _______________________________________

E-mail:  ______________________________________________

Chapter Number:  NY0489

Membership Dues:  $40.00
Sliding Fee Scale:  $39 - $20
Our Sliding Fee Scale is available to anyone who is unable to pay the full membership fee.