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Clan MacIntyre Society Membership Form

We are happy you are going to be a member of Clan MacIntyre Society and enjoy all the benefits. To join, please print this page, complete it, sign and return it with your $30.00 check to the address listed on the bottom of this page.

Name______________________________________________________Birthdate_____________________
Address__________________________________________________________________________________
City____________________________________________________State________Zip__________________
Spouse’s Name____________________________________________Birthdate______________________
Dependents_______________________________________________________________________________
________________________________________________________________________________________
Membership includes spouse and all dependents
Phone (_____)_______________________________ Day ( ) Evening ( )
E-Mail Address___________________________________________________________________________
Clan Family Connection____________________________________________________________________
Immigrant Ancestor Name (if known):_________________________________________________________
Date of Birth (if known): _____________________________Place (if known):_________________________
Port of Embarcation_________________________________Ship___________________________________
Port of Entry______________________________Year__________Spouse____________________________
Settled Where_____________________________________________________________________________

Particular Interest of Each Family Member: (Please insert name or names on each line, to match member interests)
Athletics_____________________________________Highland Dancing_________________________________
History_______________________________________Scottish Country Dance____________________________
Piping________________________________________Scottish Military History____________________________
Computers_____________________________________Genealogy________________________________________
Other_________________________________________Interest in participating in Genealogy Database? (     )

Signature_________________________________________________Date_______________________________
MAKE CHECKS PAYABLE TO: Clan MacIntyre Society, Inc.
SEND CONTRIBUTION TO:

Alan Wright, Treasurer
11936 NE 153rd Pl
Bothell, WA 98011


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