Kennett Square Area Newcomers' Club
Membership Form for 2021-2022
To be included in the Directory, this Completed Form and Dues must be received by September 30,2021
- PLEASE PRINT CLEARLY -
Last Name_____________________________________________First Name_______________________________________Spouse Name________________________________
If you live in a Development or Subdivision please provide the name_______________________________________________________________________________
Home Phone___________________________________Cell Phone____________________________________
If one number is preferred over the other, please place an asterisk in front of the preferred number.
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) 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 9/30/21)
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__________________________