NAME: ________________________________________________ SPOUSE: _________________________

ADDRESS: _______________________________________________________________________________

CITY:________________________________ STATE/PROV:_________________ZIP/CODE:___________

PHONE: (Home) __________________________________ (Bus.)___________________________________

E-MAIL ADDRESS______________________________________

CHILDREN:

_____________________________________________ 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: _____ Genealogy: _____ Committee _______________________

Other:_____________________________________________________________________________________

Please indicate your area of Scottish interest:

Music: _____ Dancing: _____ Athletics: _____ History: _____ Other: ________________________________

Please enclose a check or money order, payable to individual Clan Society, for the amount indicated below.

SIGNATURE: _________________________________ DATE: _______________

Amount and address:

USA: $25US to Clan Lamont Society of North America, PO Box 29221, Columbus, OH 43229

Canada: $15CAN to Clan Lamont Society of Canada, 485 Cobequid Rd., Lower Sackville, Nova Scotia B4C 3Y7

Scotland: Clan Lamont Society, 4 Montford Terrace, Rothesay, Isle of Bute PA20 9ER

(Phone 01700-505099 for dues information) [an error occurred while processing this directive]