Please complete the following and mail it to:

Clan Graham Society
PO Box 70
Yucca, AZ  86438
(928) 412-6120
E-mail address: nmg2415@hotmail.com

 Membership Application
USA
Please Print Legibly

Name: First_________________________ Middle___________________ Last_____________________________

 Spouse: First ________________________Middle ____________________Last ______________________________

 Wife’s Maiden Name: _________________________________________

 Street Address: ____________________________________________________________________________________

 City______________________________________ State_________________________ Zip_______________________

 Country_________________________________________

 E-mail Address _________________________________________Telephone (_______) ______________________

 I prefer my name to be listed on the membership card_____________________________________________

                                     Spouse: _______________________________________________________________________
                                                              (Maximum 26 characters including spaces)

 Annual membership dues are not required  of  children under eighteen (18).
The Annual Membership Dues shall be the same for all Membership Types:  $25.00 US $20.00 for electronic newsletter.
Make all Checks payable to Clan Graham Society.  Thank you.

 (Check One) Membership Type:___ Regular Member ____ Regular Member & Spouse                                                 ____ Associate Member      _____ Associate Member and Spouse Payment Type:  Cash_______    Check______ Credit Card_______

 CG Society use ONLY.        _{Mem App February 2002}                    Member #_____________
.                                                                                                              Assigned by Membership VP