Clan Hall Membership Application Form
Vive Ut Vivas: "Live, So That You May Live"Please print this form and mail it to:
Atlas D. Hall, FSA (Scot.),
President, Clan Hall Society
3045 Kentucky Route 321 #7
Prestonsburg, Ky 41653
Email: Clan_Hall@iname.com
MEMBERSHIP APPLICATIONMembership type: ____Family ____Individual ____Associate ___Life
Date:__________________________
Name:__________________________________________________ Citizenship:______________________
Address:_______________________________________________ Phone: (_____)____________________
E-mail Address:__________________________________________________________________________
City, State, & Zip Code:____________________________________________________________________
Occupation:_____________________________________________________________________________
Date of Birth:_________________________________________ Birthplace:___________________________
Spouse's First, Middle, and Surname (maiden name for females):
_______________________________________________________________________________________
List name(s) and age(s) of any children under the age of 18 years:
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you a dues paying member of any other Scottish Clan Society or Association? Yes / No
If yes, please list the name(s) of each:
_______________________________________________________________________________________
Briefly describe your relationship to the CLAN HALL. Allied and dependent families
include: Collin(g)wood, Crispin, De Aula, FitzWilliam, Hal, Hale, Hall, Halle, Haul(e),
Haw, Haugh, MacHale and MacHall. Associate members welcome.
_______________________________________________________________________________________
Annual FAMILY Membership (children under the age of 18 are free) dues: $20.00
Annual INDIVIDUAL or ASSOCIATE Membership dues: $15.00
* International Members please add: $2.00
Please complete as much of the requested information as possible, especially on the
surname upon which your Membership Application is based. When completed, please
return your Membership Application, Annual Dues, and Genealogy Chart
to the above address.
*Note: Membership rates are pro-rated monthly.
Applicant please do not write below this line (for official use only)
Recommended for membership by:_________________________________________________________
Membership type:____________________________________________ Dues received: $____________
Date membership began:_______________________________ Descended from:___________________
Pedigree Charts received:______________________________ Date received:_____________________
Received by:_________________________________________ Date received:_____________________
Approved by:_________________________________________ Date received:_____________________