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