Application for membership
Scots-American Society of Brevard 

#1 ________________________________   #2 __________________________________
(Last name)        (First name)                          (Last name)            (First name)

Mailing address: ___________________________________________________________
___________________________________________________________

Home Phone # _______________________________________

Email address ________________________________________

Are you a native born Scot?      #1 _____________      #2 ______________

To which Clan(s) do you belong? ______________________________________________

Do you have any talents that you would like to share with us?  (musical instruments, singing, dancing, writing, storytelling, poetry, genealogy, etc.) _______________________ _________________________________________________________________________
_________________________________________________________________________

Please print and return this application with your check attached.  Your application will be accepted at any Society function or activity or may be mailed to the address shown below.  Dues are $35 per person, couples-$55 and families-$60 per year.    Your application for membership will be considered at the next monthly meeting.

Scots-American Society of Brevard
PO Box 3325
Melbourne, FL  32902-3325