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Please print off this page and mail to the address
provided at the bottom of this form.
Check membership
category:
Individual: _____ Family: _____ (List spouse's name also)
New Member: _____
Renewal: _____
Annual membership dues: Individual: $15, Family:
$20 (upon the initial dues payment, dues are payable
in January of each year)
EMAIL: _______________________________________________________
TELEPHONE: ___________________________________________________
FULL NAME: ___________________________________________________
COMPLETE ADDRESS: ____________________________________________
_____________________________________________________________
_____________________________________________________________
I am interested in volunteering for the following
committees and activities:
Membership _____
Publicity _____
Newsletter _____
Special Events _____
Social Activities _____
Web Page _____
Education _____
Historian _____
Area Convener _____
Note: Completed applications and attached dues
payments can be mailed to:
Ulster-Scots Society of America
Attn: Glen Pratt
P.O. Box 3969
Amarillo, TX 79116
For more information contact Glen Pratt
(President) at email:
gpratt@ulsterscotssociety.com.
_________________________________________________________________
Signature/Date
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