KENNETT SQUARE AREA NEWCOMERS CLUB
MEMBERSHIP FORM FOR 2018-2019
To Be included in the Directory, this completed form and dues must be received by September 30, 2018.
Questions? Please send an email to firstname.lastname@example.org
-Please print clearly-
Last name _______________________________ First name ________________________________ Spouse ____________________________
Street Address _____________________________________________________________________________________________________________
*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 ________
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 ______________