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Clan Skene Association, Inc.

Membership Application

Please return completed application to:
Robert J. Skeens, 2nd Vice President
Clan Skene Association, Inc.
1705 Woodruff Ave.
Bethany, MO  64424-2545

Date:____________

Type of Membership:        ____ Family      ____ Individual       ____ Associate      ____ Life

Name: __________________________________________      Citizenship: ____________________

Address: _________________________________________________   Phone No: (____)__________

City: ________________________________________   State: ________   Zip Code: ______________

E-Mail Address: ____________________________________________   FAX No: (____)__________

Spouse's first, middle and surname (maiden name if female): _____________________________________

List name('s) and age(s), of children under 18 years of age:

_________________________________________     _________________________________________

_________________________________________     _________________________________________

Are you a dues-paying member of any other Scottish clan society or association? If yes, please list the name(s) of each organisation:

_____________________________________________________________________________________

If your name is not Skene, or another name of that ilk, briefly describe your relationship to Clan Skene. Septs include: Cariston, Carney/Carnie, Dyas, Dyce, Dyer, Dyess, Hall, Hallyard, MacGalliard/Halliard, Pinkieslaw/Rubislaw, Rennie, Skains, Yyel and names of these ilks.

_____________________________________________________________________________________

Annual Family Membership (children under 18 years of age free) $20.00
Annual Individual Membership $15.00
Annual Associate Membership $15.00

PLEASE NOTE: For all memberships outside the normal United States postal zones, add $2.00 to the above prices. Please complete as much of the requested information as possible, especially on the surname upon which your application is based. Forward your completed application to the Clan 2nd Vice President whose address is listed above. All membership dues payable in the equivalent of U. S. Currency Dollars.

Based on the Revised Form of 29 October 1996)
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Applicant, please do not write below this line.

Recommended for membership by: ________________________________________  

Membership type:  ______________    Dues Received: $_______________

Date membership began: _____________________   Descended from: _______________

Pedigree Chart received: ___________    Date received: __________   Received by: _______________

Approved by: ________________________________________    Date approved: _________________