Name_____________________________________________ Spouse______________________________
Address ________________________________________________________________________________
City______________________________________________ State________ Zip ______________________
Development _________________________________Township __________________________________
Telephone _________________________ Cell ___________________
E-mail ________________________
Employment Information: (optional)
Full time ____ Part time ____ Retired ____ Occupation: ____________________________________
Volunteer Positions Held __________________________________________________________________
Previous Location _____________________________
Month and day of birth _______________________
Continuing Member _________ New Member _________
How did you hear about us? _______________________________________________________________
Dues for 2008 – 2009 club year are $25.00 - $10.00 after Jan. 2009.
Payment is due upon receipt of this form. If your completed form and dues are not received by August 31, 2008, your name will not be included in the membership directory. Please make your check payable to Newcomers Club of West Chester and mail to:
Jane Mangelli 62 Cherry Farm Lane, West Chester, PA 19382 (610) 399 – 4645
I hereby acknowledge that Newcomers Club of West Chester is not liable for any injury, accident or loss which I may sustain at any club functions.
Signature: ________________________________________________
Date ________________________________
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I am interested in promoting the continuing success of the club in the following ways: (This does not constitute a commitment.)
__ Offer my home for a social event __ Computer skills __ Chair a Special Interest Group __ Contribute food for an event __ Help with event set-up __Serve on the Exec. Board __ Help with holiday luncheon __ Finance Background __ Historian __ Produce directory/newsletter __ Webmaster (update info) __ Public relations experience __ Support community service activities __ Help with fundraising __ Socials (Ex. Super Bowl Party)
Would you be willing to share other interests or talents with the club? Please explain.
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