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Clan Montgomery Society International
Application and Renewal Form

I would like to become a part of the
"Thousand Year Tradition"
Of Clan Montgomery Society

Renewing Members Please Include Your Full Name, Address and CMSI Number

New Membership (  )      Renewing Membership (  )     Gift Membership (  )    

Name of Applicant/Recipient/Member___________________________________________________________ CMSI No.__________

Street Address_________________________________________ City________________________ State______ Zip Code________

Telephone___________________ Home (  ) or Mobile (  )      Country of Residence_________________________________________

Applicant's Occupation_________________________________________________________________________________________

Spouse’s Name_____________________________________________________ Occupation________________________________

Montgomery Relation, or
Reason for Interest in Clan Montgomery___________________________________________________________________________

E-Mail Address_____________________________________________   I would like to receive the "Gardien" by E-Mail   Yes (  ) No (  )

Please indicate your Area of Interest

Contribute to the "Gardien" (  )        Hosting Clan Tents (  )        Helping in the Genealogy Arena (  )  

Helping with the Annual General Meeting (  )         Other______________________________________

This is a Gift From__________________________________________________________________________ CMSI No.__________

Street Address_________________________________________ City________________________ State______ Zip Code________

Dues for the Society are from January 1 to December 31 of the year in which you join, and are renewable each January. Members who join from January to September will receive Society newsletters published during that period of time. Joining from October to December includes membership for the entire following year. Membership is open to those interested in the purposes to which Clan Montgomery Society is dedicated. If you wish to enroll friends or relatives, please fill out a separate application for each. New members will be listed in the CMSI newsletter, the “Gardien.” Dues and contributions are tax deductible.

Please indicate your Choice of Membership

Annual Dues and Renewals
Life Memberships
(  ) For USA Members         - Individual or Family, $25.00 (USD)
(  ) Life Membership - Individual or Family, $300 (USD)
(  ) For Non-USA Members - Individual or Family, $30.00 (USD)
(  ) Life Membership - Individual or Family, $350 (USD)

Enclosed is my check in the amount of_______________  Make checks payable to Clan Montgomery Society International (CMSI)

Signature of New Member_________________________________________________________________ Date_________________

I do not wish to have my name listed as a new member in the "Gardien" (  )

How did you hear of Clan Montgomery?    Relative (  )   Website (  )   Highland Games (  )   Other (  ) ___________________________

Send Payment to:
Robert Fields, Treasurer
90 Sycamore Drive, #385
Elizabethtown, PA 17022 U.S.A.
Clan Crest