CLAN SUTHERLAND SOCIETY
OF NORTH AMERICA, INC.

MEMBERSHIP APPLICATION

Dues and Membership

Dues and membership are based on the calendar year. All monies are payable in U.S. funds only. An initial processing of $5.00 is charged all new members. This "one-time" assessment is paid at the time the first member of a household joins the Society and must be included with the initial dues payment. Additional members of the same household my join under the same initial processing fee. Family memberships are available within the same constraints.

Enrollment periods and fees are prorated as follows:

Initial % Family Adult Junior # Overseas

Jan/Mar 5.00 25.00 18.00 5.00 20.00

Apr/Jun 5.00 18.75 15.00 5.00 16.50

Jul/Sep 5.00 12.50 12.00 5.00 13.50

Oct/Dec* 5.00 31.25 21.50 6.25 25.00

% Payable with appropriate category below.
# Under 18
* Dues paid during Oct/Dec include the final quarter of the year as well as the entire following year. Life memberships are available at fifteen times the annual rate shown in column one and may be paid quarterly.

Detach & return TODAY

Date________________

Full Name_______________________________Phone Number:(______)___________

Address________________________________Zip__________________

Birth Place_________________________Birth Place__________________________
Occupation__________________________

Spouses Name_____________________(Last/Maiden)__________________________

Children's Names_________________________________________________

ARE YOU: