NMS Form

							                  Non-Member Surcharge Submission Form
Kingdom Exchequers: Send printout and check to the Corporate office in Milpitas, ATTN: Renee
               Email soft copy to the Society Exchequer

Local exchequers: Contact your kingdom exchequer for proper mailing address.
                 Do not send any checks or paperwork to the corporate office.

    Kingdom:                                                   Date Due:
        Date:                                             Check Number:

                                                                                       # of
  Event Date                                                                           Paying
(Sort events by                                                                 # of   Non-              Transfer
      Date)                 Branch                      Event Name              Adults members NMS $     Check #




                  TOTAL included in check                                                         0.00

Submitted by:
Sender's Name:
Street Address:
City:
State/Province:                               Zip or Postal Code:
Telephone:
SCA Name:
email: