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Clan Montgomery Society International
Application and Renewal Form

( Renewing Members Please Include Your Full Name, Address and CMSI Number )
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.
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, $25.00 U.S.  _____ Life, $300
Annual Dues For non-USA members _____ Individual or Family, $30.00 U.S.  _____ Life, $350
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:
LaDell Montgomery, Treasurer
Clan Montgomery Society International
1505 Bluestone Drive
Cumming, GA 30041-2129 U.S.A.