Newcomers Club of West Chester

2010 - 2011 Membership Application or Renewal Form

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 2010– 2011 club year are $25.00.

Payment is due upon receipt of this form. If your completed form and dues are not received by August 31, 2010, your name will not be included in the membership directory.

Please make your check payable to Newcomers Club of West Chester and mail to:

Jennifer Ely 1104 Amalfi Drive, West Chester, PA 19380

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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