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.
Membership forms are accepted throughout the year.
- PLEASE PRINT CLEARLY -
Last Name___________________________________
First Name___________________________________
Spouse Name__________________________________
Address_____________________________________
City/State/Zip_________________________________
If you live in a development or subdivision, please provide the name of the development/subdivision___________________________
Home Phone___________________________________
Cell Phone____________________________________
Please place an asterisk in front of the preferred number.
Email____________________________________________
If you have provided an email address, pertinent last minute alerts and updates,
as well as the Monthly Newsletter, will be sent directly to your inbox.
Birthday: Month____________ Day______________
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 your voting privilege
(Guide and Directory, Page 3, Constitution, Article III, Section 2).
If you don't have a home printer and prefer receiving 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,
610-274-8708 (To be included in the Directory your form and dues must be received by September 30.
I hereby acknowledge that KSANC is not liable for any injury, accident, or loss which
I may sustain at any club function.
Signature: _____________________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____________________________________________
Copyright © 2022 Kennett Square Area Newcomers - All Rights Reserved.
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