Please print the following and mail with cheque to:

 Clan Graham Society

Royce Graham,
Canadian Membership Chairperson

262 Bicknell Crescent,
Kingston, ON, K7M 4T6

Tel. (613) 389-4341

Email: royce.graham@sympatico.ca

                                                                                                  Please print legibly

 Name:  First  ____________________      Middle _____________________     Last __________________________

 

Spouse:  First ____________________     Middle _____________________      Last __________________________

 

Wife’s Maiden Name: ____________________________________________________________________________

 Street Address: _________________________________________________________________________________

 City:   ________________________________    Province ______________    Postal Code: ____________________

 Country: ________________

 Email Address: ________________________________________________   Tel. (____)______________________

                              PLEASE PRINT CLEARLY

 I prefer my name to be listed on the membership card as: ____________________________________________________

              Spouse: (maximum 26 characters including spaces) _____________________________________________________

 Membership is $25 CDN a year for Regular as well as Regular with Spouse.   Associate memberships are available at $25CDN to persons with a genuine interest in the objectives and principals of Clan Graham Society and who do not have Graham lineage.

 If you wish to receive the Clan Graham Newsletter by email, membership is only $20.  Please provide your current email address above. You will need to advise the Membership Chairperson of any changes to this address which might occur in the future so that you do not miss receiving the CGS Newsletter by email.   Life memberships are also available. Make all cheques payable to Clan Graham Society.

 Thank you.

 Membership type: (check one) Regular ____    Regular & Spouse ____    Associate ____    Associate & Spouse ____

 Payment Type:   Cash _____ (Only if paying in person)    Cheque _____    Amount enclosed ___________

 Mail this Membership Application with your cheque to the address given above.

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                                                                    For GCS use ONLY: 

 Region _____________________ Commissioner _______________________________Membership # _______________    

 Form revised September 1, 2006