Name as you want it to appear on the membership certificate:
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First Name: Last Name:
Address for this membership:
Zip/Postal Code: Country:
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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)
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.
If you wish, you may pay $100.00 down and $100.00 annually.
If you prefer to pay by check, just print this form and mail it and the check to Clan MacDougall Society of NA, P.O. Box 338047, Greely, CO 80633.
When you submit this form, a copy will be e-mailed to you for your records.
To verify you are a real person, please copy the digits from the image into the box above before attempting to send this application.