2008-2009 Renewing Membership Form

Renewing Members print your name on the first line and SIGN BELOW.
Please take time to check your directory listing. Please put any corrections or changes in your information below.

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 and will be deleted from the Newsletters' mailing list.


[ ] RENEWAL USE INFORMATION FROM THE DIRECTORY

[ ] RENEWAL WITH CORRECTIONS OR ADDITIONS

Name ____________________________________________________

Spouse __________________________________________________

Address_______________________________________________________________

City__________________________________ State_______ Zip________________

Telephone # __________________________ Fax #__________________________

Cell Phone #__________________________ E-Mail_________________________

Month and day of birth ____________________

Development________________________________________

Township__________________________ Previous location__________________

Originally from_________________________________

How did you hear about us?_____________________________________________

Dues for 2008-2009 club year are $25.00

Please complete form and mail it with your check payable to NEWCOMERS CLUB OF WEST CHESTER


Mail to:

Jane Mangelli
62 Cherry Farm Lane
West Chester, PA 19382



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.

Name:_____________________________________________

Date:____________________________