To Be included in the Directory, this completed form and dues must be received by September 30, 2018.

Questions? Please send an email to

-Please print clearly-
Last name _______________________________  First name ________________________________ Spouse ____________________________

Street Address _____________________________________________________________________________________________________________
City/State/Zip ______________________________________________________________________________________________________________

*If one number is preferred over the other, please place an asterisk in front of the preferred number

Home Phone _________________________Cell Phone __________________________ Birthday Month ________________   Day ________

Email __________________________________________________________________________________________________________

If you do not provide an e-mail address, you will not receive periodic e-mail updates with pertinent information

New Member ________  Renewing Member ________  **Honorary Member (must be a renewing member, age 75 or older)

**Honorary Member - Current members age 75 or older are not required to pay yearly dues: however, by choosing this option,    you forfeit their voting privileges. (Guide and Directory, Page 3, Constitution, Article III, Section 2).

If you have provided an e-mail address, the monthly KSANC newsletter will be delivered to your inbox

To receive the monthly KSANC newsletter by regular mail, please check here _______

I hereby acknowledge that KSANC is not liable for any injury, accident, or loss which I may have sustained at any club function.

Please send your check for $25.00 yearly dues, payable to KSANC, together with your completed 

Membership Form (please do not staple check to form or cut off any part of this form) to:

           Membership Chair: Carol Buckwalter, P. O. Box 171, Landenberg, PA 19350

(To be included in the Directory, your form and dues must be received by September 30, 2018.)

We would like to know how you heard about Kennett Square Area Newcomers Club (KSANC)

     Friend                     ____________                          Website                      _____________                          Other       _____________         

     Neighbor                ____________                          Flyer                           ______________

     Local Newspaper  ____________                          Real Estate Agent     ______________