CLSA

MEMBERSHIP APPLICATION
For Office Use Only
Membership No.:      __ __ __ __
Registrar:

           /         /20

Treasurer:

           /         /20

Secretary:

           /         /20

Genealogist:

           /         /20

Form: Apply.htm v1.08 2024-09-09

Instructions

Complete this form and mail it with your cheque or money order or proof of electronic payment to:

Clan Lindsay Society of Australia
Unit 18, 37 Derrima Road
QUEANBEYAN NSW 2620
Australia

Clan Lindsay Society of Australia
BSB number: 032719
Account No: 588606
Remitter Name: include your NAME

Applicant Information

My full name as I want it to appear on my membership certificate: ____________________________________________

Postal address:
____________________________________________

____________________________________________
Post Code:
___________________Country:__________________
Phone:
____________________________________________
E-mail:
____________________________________________

Our policy is to protect the privacy of all living persons.  The information on this application may be used by CLSA to promote genealogical research where it does not conflict with our privacy policy.


Signature: _______________________________

Date: ____ /_____ /20____

Qualifications

My connection to the Clan is through the following surname, however spelt (circle one):

Affleck

Byers

 Cobb

Crawford

 Deuchar

Downie

 Fotheringham

Lindsay

 Rhynd

Summers

 

 

You must meet one of these criteria:

1.

My earliest known Scottish ancestor was:

____________________________________________
of the surname circled above and traced in the Genealogy section.

OR
  
2.

I am the spouse of qualifying member:

____________________________________________

Membership Type

Circle the appropriate fee:

Membership category (for 1 year)

Fees (A$)

Family (one household)

$35.00

Individual Membership

$25.00

Couple over 65 $25.00
Concession (retiree, student, etc) $15.00

Genealogy

Please print and use only maiden names:

Member: ______________________ Spouse: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________
       
Child 1: ______________________ Child 3: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
       
Child 2: ______________________ Child 4: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________

 

Complete at least enough to show your connection to the Clan.

Member's father: ______________________ Member's mother: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date died: ______________________ Date died: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________
       
Grandparent: ______________________ Spouse: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date died: ______________________ Date died: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________
       
Great grand parent: ______________________ Spouse: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date died: ______________________ Date died: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________
       
2nd great grand parent: ______________________ Spouse: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date died: ______________________ Date died: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________
       
3rd great grand parent: ______________________ Spouse: ______________________
Date born: ______________________ Date born: ______________________
Where: ______________________ Where: ______________________
Date died: ______________________ Date died: ______________________
Where: ______________________ Where: ______________________
Date married: ______________________ Where married: ______________________

Please attach any additional information (additional spouse(s), children, extra generations, etc) on a separate sheet of paper.

Thank you