Clan Lamont Society of North America

MEMBERSHIP APPLICATION

NAME: __________ SPOUSE:

DESIRED NAME ON MEMBERSHIP BADGE IF DIFFERENT THAN ABOVE_________

____________________________________________________________

ADDRESS: ___________________________________________________________

CITY:__________________________ STATE:ZIP:_

PHONE: (Home) () _ (Bus.) () ______

E-Mail ________________________________________________________________

CHILDREN:

_________________________________ BIRTH DATE: _

Use the back of this form for any further information such as additional children or genealogy.

Please indicate the areas in which you might be willing to help:

Manning Games Tents: ___ Newsletter: _ Area Commissioner _ Officer: ___

Board of Directors: ___ Genealogy: _ Committee _ Other:__________________

Please indicate your area of Scottish interest:

Music: ___ Dancing: _ Athletics: _ History: _ Other: ___________________

Please enclose a check or money order, payable to CLAN LAMONT SOCIETY of N. A., for the sum of $ 25, which includes $15 first years dues, and $10 initiation fee.
Family Membership is $35.

SIGNATURE: ___________________ DATE: _

Clan Lamont Society of North America

MEMBERSHIP APPLICATION

NAME: ________________________________ SPOUSE: ______________________

DESIRED NAME ON MEMBERSHIP BADGE IF DIFFERENT THAN ABOVE_________

ADDRESS: ___________________________________________________________

CITY:__________________________________ STATE:____________ZIP:_________

PHONE: (Home) (______) ___________________ (Bus.) (______) ________________

E-Mail ________________________________________________________________

CHILDREN:

_____________________________________________ BIRTH DATE: _____________

_____________________________________________ BIRTH DATE: _____________

_____________________________________________ BIRTH DATE: _____________

_____________________________________________ BIRTH DATE: _____________

Use the back of this form for any further information such as additional children or genealogy.

Please indicate the areas in which you might be willing to help:

Manning Games Tents: _____ Newsletter: _____ Area Commissioner _____ Officer: _____

Board of Directors: _____ Genealogy: _____ Committee _____ Other:____________________

Please indicate your area of Scottish interest:

Music: _____ Dancing: _____ Athletics: _____ History: _____ Other: _____________________

Please enclose a check or money order, payable to CLAN LAMONT SOCIETY of N. A., for the sum of $ 25, which includes $15 first years dues, and $10 initiation fee. Family Membership is $35.

SIGNATURE: _________________________________ DATE: _______________

NAME: __________ SPOUSE:

CITY:__________________________ STATE:ZIP:_

PHONE: (Home) () _ (Bus.) () ______

_________________________________ BIRTH DATE: _

_________________________________ BIRTH DATE: _

_________________________________ BIRTH DATE: _

_________________________________ BIRTH DATE: _

Manning Games Tents: ___ Newsletter: _ Area Commissioner _ Officer: ___

Board of Directors: ___ Genealogy: _ Committee _ Other:__________________

Music: ___ Dancing: _ Athletics: _ History: _ Other: ___________________

Please enclose a check or money order, payable to CLAN LAMONT SOCIETY of N. A., for the sum of $ 25, which includes $15 first years dues, and $10 initiation fee.
Family Membership is $35.

SIGNATURE: ___________________ DATE: _