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$ CURRENCY CONVERSION CALCULATOR $

AVAILABLE TO EXPEDIATE YOUR SUPPORTING MEMBERSHIP

Clan MacTavish is committed to protecting your personal information and privacy. With this in mind we will only use your personal data within the administration for the purpose of day to day business.

* WE WILL NOT RELEASE ANY PERSONAL INFORMATION TO ANY OUTSIDE SOURCES WITHOUT YOUR PRIOR WRITTEN APPROVAL EXCEPT WHEN ORDERED BY A COURT OF LAW

ONLINE APPLICATION

PLEASE COMPLETE ALL FIELDS

	Date of Application	February 08, 2010

	Type of Membership	Annual ( $30.00 USD ) Senior 65+ ( $20.00 USD ) Life ( $300.00 USD )
	New or Renewal?	Please indicate with your surname below whether this is a NEW membership or RENEW with ID #
	Surname
	Given Name
	Middle Initial

	Current Address
	City
	State / Province
	Zip Code / Postal
	Country

	Telephone Number	( )
	Work Number	( ) Ext

	Email Address
	Alternative Email Address

	What Surname do you believe connects you to this Clan?

	Scottish Interests or Affiliations

	Would you be interested in volunteering for Clan projects?

	I give Clan MacTavish USA Inc. and Clan MacTavish International permission to share my address, phone number, and email address with other members of Clan MacTavish USA Inc. and Clan MacTavish International.
		Payment options will be presented following submission of this form. * By submitting this membership application you have read and accepted the privacy statement stated above.

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