Stockton Well Keystone Membership

Application for Stockton Well Keystones Membership
To the officers and members of Stockton Well Keystones (SWK) a subordinate organization of Keystone Agricultural Society (KAS) -

I/We the,
Family or Individual's Last Name*
respectfully petition the officers and members of the Stockton Well Keystones (SWK), a chapter of the Keystone Agricultural Society (KAS) to be enrolled as a member in your organization.

In presenting this application, I/we promise to professionally and ethically uphold myself/ourselves with the Society and members of the SWK and KAS. Instigating and agitating are not permitted and are grounds for suspension and potential revocation of membership by the Board.

All quarterly due are based on the time of application. For example, if you are applying in August, two quarterly dues must accompany the application along with the application fee.

Applicants Information*

	Full Name	Date of Birth	Occupation	Signature
Applicant 1
Applicant 2
Applicant 3
Applicant 4
Applicant 5
Applicant 6
Applicant 7
Applicant 8

Parent/Guardian Name if applying for a Individual Youth Membership

First NameLast Name
I/We hereby grant the Keystone Agricultural Society (KAS) and its subordinate organization Stockton Well Keystones (SWK) permission to use my/our likeness in a photograph or graphic representation, in any and all of its publications, including website entries, without payment, or any other consideration..*

I agree
I/We understand and agree that these materials will become the property of KAS and its subordinate organization SWK and will not be returned. I/We hereby irrevocably authorize KAS to edit, alter, copy, display, distribute, or any other uses for the purposes of publicizing the KAS programs, events, website content, or for any other promotional or marketing purpose.*

I agree
In addition, I/We waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I/We waive the right to royalties or other compensation arising or related to the use of thephotograph.*

I agree
I/We hereby release and forever discharge KAS, SWK, and any subordinate organizations from all claims, demands, and causes of action which I/We, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*

I agree
Name First Name Last Name Signature Signature*
*all members 18 and over must fill out this section and sign.
Name First Name Last Name Signature Signature
*all members 18 and over must fill out this section and sign.
Name First Name Last Name Signature Signature
*all members 18 and over must fill out this section and sign.
Contact Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number 1*

Area CodePhone Number
Phone Number 2

Area CodePhone Number
Email 1*
example@example.com
Email 2
example@example.com
Fees - Must be paid before initiation

Membership is January to December. Members who join after March 31 will have pro-rated dues after the first quarter.
My Products*
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Youth Individual Membership$10.00
Ages 5-13

Family Membership$40.00
One Membership for your whole Family!

Individual Membership$20.00
Ages 14+

2023 Previous Membership Dues $ Free
If you paid dues between July - December select this option. 2023 fees will be verified and waved if within the July - December 2023 time frame.

Total $0.00
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Application for Stockton Well Keystones Membership

Contact Information

Fees - Must be paid before initiation