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

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 _______

Please check the type of membership that applies to you

New Member __________ Renewing Member __________ Honorary Member (must be a renewal, after 75 or older*__________


*Honorary Member - Current members age 75 or older are not required to pay yearly dues: however, bychoosing

      this option, they forfeit their voting privileges.(Guide and Directory, Page 3, Constitution, Article III, Section 2).

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


Please sign­­­­­­­­­_____________________________________________________________________________ Date ___________________________________

Yearly dues are $25.00

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) to:

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

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

  • Friend                     ___________
  • Neighbor                ___________
  • Local Newspaper  ___________
  • Website                   ___________
  • Flyer                         ___________
  • Real Estate Agent   ___________
  • Other                       ___________