Clan McCord Society
Application for Membership

Note:  The New Member Application Fee is $10.00 plus the annual dues of $15.00 for a total of $25.00 to join.   Please print this page and fill it out completely.

Today's Date:____________________

Full Name and Alias_________________________________________________________

Home Address________________________________________________________________

City, County, State, ZIP____________________________________________________

Internet Address________________@___________________________________________

Phone_________________________    FAX_______________________________________

Place and Date of Birth________________,  __________________________________

Occupation and Company (if retired, give previous calling)__________________

Business Address____________________________________________________________

Full Name of Spouse_________________________________________________________

Spouse's Place and Date of Birth and Occupation_____________________________

Names, Dates and Places of Birth of Children________________________________

(Please use reverse if more space is needed.)

I would be willing to volunteer to help with the following:  qHighland Games
qRecruiting Members   qNewsletter        qResearch
qComputerize Data for Researchers qOther___________________________________

Father's Full Name and Date of Birth________________________________________

Mother's Full Name and Date of Birth________________________________________

Earlier and Other Ancestors_________________________________________________

Please make your $25.00 check payable to Clan McCord Society and send to:

Jean Hayter, Sec. Treasurer, Clan McCord Society, 3820 Orloff Avenue, Bronx, N.Y. 10463-2641


Member of COSCA, the Council Of Scottish Clans and Associations, Inc.

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