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:____________________________
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