Kennett Square Area Newcomers' Club

  Membership Form for 2020 - 2021

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PLEASE PRINT CLEARLY -

Last Name_____________________________________________First Name_______________________________________Spouse Name________________________________


Street Address__________________________________________________________________________________________________________________________________________


City/State/Zip___________________________________________________________________________________________________________________________________________


If you live in a Development or Subdivision please provide the name____________________________________________________________________________________


  *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_________________


E-mail___________________________________________________________________________________________________________________________________________________


                             If you have provided an E-mail address, pertinent last minute alerts and updates as well as the Monthly Newsletter

                                                                                               will be sent directly to your inbox.


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


 If you don't have a printer and need to receive the Monthly Newsletter by regular mail, please check here   ___________________

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

                                                                                                Membership Form (please do no staple or tape check to form)

                                                                         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 9/30/20)


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


Please Sign__________________________________________________________________________________________and date____________________________________________


                                      We would be pleased to know how you heard about the Kennett Square Area Newcomers Club


                                     Friend_____________________________________                                      Neighbor___________________________

                                            Local Newspaper__________________________                                      Website _________________________

                                            Flyer_______________________________________                                     Real Estate Agent___________________

                                           Other______________________________________