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Clan Montgomery Society International
Application for Membership

( Renewing Members Please Include Your Full Name and Membership Number )

Dues for the Society are from January 1 to December 31 of the year in which you join, and will include copies of all issues of the News Magazine for that year. Membership is open to those interested in the purposes to which Clan Montgomery Society is dedicated. Dues and contributions are tax deductible. If you wish to enroll friends or relatives, please fill out a separate application for each.

Name of
Recipient,
Member, or
Applicant _________________________________________________________ CMSI# _________

Street Address ________________________________________ City ________________________

State _________ Zip ___________ Country __________________ Telephone _________________

E-Mail Address ____________________________________________________________________

Applicant's Occupation _____________________________________________________________

Spouse’s Name ____________________________________________________________________

Reason for Interest in Clan Montgomery _______________________________________________

___________________________________________________________________________________

I desire the following type of membership       (  ) New       (  ) Renewing       (  ) Gift

Annual Dues For USA Members _________ Individual or Family, $20.00 U.S.  _____ Life, $250

Annual Dues For non-USA members _____ Individual or Family, $25.00 U.S.  _____ Life, $300

Enclosed is my check in the amount of _________________

Signature ___________________________________________________ Date _______________

Please mail this form with your check or money order made out to Clan Montgomery Society International to:

Alice Montgomery, Treasurer
Clan Montgomery Society International
2071 State Highway 29
Johnstown, NY 12095 U.S.A.