Clan Leslie Society
Australia & New Zealand

(CLANZ)




MEMBERSHIP FORM

Kindly print and fill out this form and return to the address below

Surname:  
First Name:  
Middle Name(s)  
Street Address:  
Suburb/Town & Post Code:  
State:  
Country:  
Telephone Number & Area Code:  
Email Address:  
Date of Birth:  
Occupation:  

Please indicate by cross or tick:

  [  ] I am of Scottish ancestry & a lineal descendant of Leslies, or a Sept of Leslie in Scotland.

  (Please circle Sept where applicable & allow for various spellings)

Septs:   Abernethy,    Bartholomew,    Cairney,    Laing,    More.

  My Leslie or Sept ancestor is/was:____________________________________

  who is/was my (state relationship to you):______________________________

  [  ] I am not a lineal descendant of Clan Leslie or its Septs. (Associate Membership)

  [  ] I'm a New Member.                                                [  ] I'm Rejoining.

Membership Fees are: AU$25.00 per annum & NZ$29.00 per annum.


I hereby apply for membership in the Clan Leslie Society, under the provisions established by the Chief of the Clan.
I certify that the above information is true to my best knowledge and belief.
I declare that if accepted for membership, I will observe the rules and regulations of the Society and will promote its welfare to the best of my ability.

Signature:___________________________              Date:_____________________


Please send this Application Form and Membership Fee of AU$25.00 NZ$29.00 (cheque/money order) to:
Clan Leslie Society of Australia & New Zealand (CLANZ) 43 Rosedale Road, Gordon, NSW, 2072, Australia.
WELCOME TO CLANZ!!