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					                   Non-Member Surcharge Submission Form
Kingdom Exchequers: Send a copy of this form and your check to the Corporate office in Milpitas, ATTN: Renee
             Email soft copy to the Society NMS Deputy and cc 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
                                                                                 Paying
Event Date (Sort                                                          # of   Non-    # of VIP             Transfer
events by Date)             Branch                     Event Name         Adults members Pass       NMS $     Check #




                   TOTAL included in check                                                             0.00
                   Total # of VIP Passes cards sent

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

				
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