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KANC Member Registration
Name____________________________________________________
Address__________________________________________________
City__________________________________ State__________ Zip____________
Phone_________________________________________
Cell___________________________________________
Email____________________________________________________ (Please print clearly as newsletters are sent by email)
Spouse/partner__________________ Birthday: M________D________
Hobbies and Interests__________________________________________________
New member? (Y/N) ____________
How did you find out about KANC______________________________
Dues: $20.00* (If you are a current member and have attained the age of 90, you no longer need to pay dues. You need to let the membership chairperson know).
*Note: If you are a new member and join during February, March, or April the dues are half price. If you join during May you pay full price, but it covers the following year.
Please complete this form and return it with a check made payable to KANC to: Pat Rose, 7509 St. George Circle, Portage, Michigan 49024