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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

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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_______________________________________________________________________________

Home Phone___________________________________Cell Phone____________________________________

​If one number is preferred over the other, please place an asterisk in front  of the preferred number.

​​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.

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 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__________________________