Rev. 07/2010

Application For Membership To Clan Bailey International

CONTACT INFORMATION

Name: ____________________________________________________________________
Address: __________________________________________________________________
City: _______________________________ State/Province: _______________________
Zip/Postal Code: __________________ Country: _________________________________
Phone: ___________________ E-mail: ________________________________________
Full name as I want it written on my membership certificate (If different from above):

__________________________________________________________________________

ACTIVITIES

I would like to hear about, discuss, or volunteer in the following Clan Bailey International
activities:

_____ Genealogy/Genealogical Research
_____ Highland Games or other Scottish gatherings
_____ Highland dance, music, etc.
_____ Celtic crafts
_____ Other activity I would like to be involved in: _________________________________

DUES
Standard dues are US $35 per year.

I am enclosing a check for US$ _____ for _____ year(s) membership fees.

Prices effective as of June 2008. For information regarding senior discounts, group rates,
family rates, lifetime memberships, etc, please contact Denise Beasley by email at
Membership@clanbaileyintl.com
Please mail completed application and check to:
Clan Bailey International
16147 S Apperson Blvd
Oregon City OR 97045 USA