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WELCOME WAGON SOCIAL CLUB
MEMBERSHIP FORM


New Member Renewing Member Year Joined ______________

Name ___________________________________Address ___________________________________

Phone Number _________________________ E-mail Address ________________________________

Birthday Month/Day _________________________ Husband's Name __________________________

Children's Names/Ages _______________ ________________ _______________ ________________

Last Place of Residence _________________________ Hometown _____________________________

Special Interests ______________________________________________________________________

Would you be available to help with various committees? Yes No

Activities Offered: (circle those of interest to you)
Book Club Coffee Club Daytrippers
Game Day Golf Lunch Bunch
Lunching In  Movie Daze Night Out
Scrapbooking Social Bridge Walk Group
Wine and Cheese Night    

Suggestions for others:

Please mail this form with your $20.00 (payable to Welcome Wagon Social Club) to:

Sharon Kerns

1161 Bernard Drive

Reading PA   19605