Membership Application

New  Renewal   Your membership number if available:

Name as you want it to appear on the membership certificate:

Preferred postal mailing name for this membership:
First Name:   Last Name:

Address for this membership:
City: State/Province:
Zip/Postal Code: Country:

Member email*:

If this membership is a gift, please enter the giver's e-mail address and name below so we can send a copy of this application and match the payment to the application.
Giver's name and surname:
Giver's email*:
Gift recipient's name and surname:
Gift recipient's email:

*By providing your email address you agree to allow the Society to include you in its informative electronic newsletter and bulletin mailings. Your contact information is not shared outside of the Society.

Phone number for this membership:

Year of birth for this membership:

Membership spouse's name: Spouse's year of birth:

Where did you hear about the Clan MacDougall Society?
At Games or other event (please specify)
Website
Facebook
Other (please specify)

Please feel free to add any other comments you feel are appropriate.

Society dues are payable in US funds on a calendar year basis. International members are encouraged to use a credit card. Canadian members may write a check in Canadian dollars drawn on a Canadian bank using the current exchange rate.
You can also pay on line by credit card or with PayPal for added security and convenience. After submitting this form, you will be automatically redirected to the PayPal payment widget. The PayPal widget will process a standard credit card payment if you prefer to pay by credit card.

Regular Membership US$   1 year: $25.00
2 years: $48.00
3 years: $70.00
4 years: $91.00
5 years: $111.00

OR

 Life Membership US$                      

Under 40 years of age: $400.00
40 years of age or older: $300.00

If you prefer to pay by check, just print this form and mail it and the check to:
Clan MacDougall Society of NA
C/O Dana Chandler, Treasurer
P.O. Box 282
Garwood, NJ 07027.

When you submit this form, a copy will be e-mailed to you for your records.

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