KENNETT SQUARE AREA NEWCOMERS CLUB 

MEMBERSHIP FORM FOR 2017-2018



Questions? Please send an email to membership@ksanc.org

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                       ___________