CLAN ROSS ASSOCIATION OF CANADA MEMBERSHIP FORM

CLAN ROSS ASSOCIATION OF CANADA, INC. - MEMBERSHIP FORM

NAME: ___________________________________ PHONE: ___________

ADDRESS: __________________________________________________

____________________________________ POSTAL CODE: _________

SPOUSE'S NAME: ____________________________________________

OTHER INFORMATION

E-mail Address: _____________________________________________
Fax: ______________________________________________________
WebSite: __________________________________________________

If your surname is NOT within the Clan Ross families, please explain your relationship:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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NOTES

Annual Dues: 1 year for $15 per individual or family, payable on January 1st each year.
Members from the USA should pay $21 in US funds to cover the higher costs of mailing the newsletter and other items. Individuals from other countries ... please enquire of the Membership Chair for rates.
New members may join at any time of the year. A free copy of the last newsletter will be sent upon joining, as well as future newsletters as published quarterly.
Please print a separate form for a "Gift Membership".
Donations towards current and future projects may be considered at this time.

A cheque made payable to the Clan Ross Association of Canada, Inc. for $ __________ is enclosed.


MAIL TO: Andy Ross Thibodeau 910 Dearness Drive London, OntarioN6E 1N5	Please check the applicable box(es). Renewal New Membership Gift Membership Donation (included)