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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_______________________________________________________________________________

Home Phone___________________________________

Cell Phone____________________________________

​If one number is preferred over the other, 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 9/3

 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__________________________