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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 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____________________________________________