Return Application to:		Barbara Ferguson				Member number:
			PO Box 2633				Date Joined:
			Cave Springs OR 97523
			babs@outlawnet.com
		Clan Fergusson Society of North America
			APPLICATION FOR MEMBERSHIP
I hereby apply for membership in the Clan Fergusson Society of North America as a:
									Enclosed
	Regular Member		$30.00						$
	(includes spouse & children under 18)
	Associate Member		$30.00						$
	(not a FERGUSSON / SEPT but have a genuine interest in CFSNA)
	Life Member								$
	(under age 60 - $500.00; age 60 & over - $300.00)
Date:				Signature:
Name: (please print)		Mr. Mrs. Ms.
Home Address:							Phone:
			(number & street)					(include area code)
							Zip:
		(city, state or province)							(8 digit)
Date & Place of Birth:
Occupation:							Email
Business Address:
						Business phone:
								(include area code)
Spouse's Full Name (with maiden name if applicable):
Name & birth dates of children:
* If your surname is not one of those eligible for membership, please explain your relation to a direct ancestor of eligible name:
Sponsor:					CFSNA Secretary:
Please list on the reverse side the names & addresses of others who might be interested in joining the
		Clan Fergusson Society of North America