No._____________

New Membership_____ Renewal _______ Date____________

Name_____________________________________________

Name to be shown on membership Certificate(_____________________________)

Email Address: ____________________________

Home Address_______________________________________________________________________

Phone Number (______)______________

Spouse's Name___________________

Name and relation of earliest known Anderson ancestor_____________________________

Place and date of ancestor's birth_________________________________________________

Please list any of your family members activity participating in Scottish related arts: (i.e. piping, Highland
Dancing, drumming)__________________________

Please note any special comments or interest on reverse side.

Membership dues: $ 20.00 per year

Make Check payable to: Clan Anderson Society.

Membership dues and applications may be mailed to:

Clan Anderson Society
3734 Hunting Ridge Dr
Lilburn, GA 30047