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[Please PRINT this form and mail it with your Membership Fee]

(Kindly complete the following information for our records)

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

Please indicate by cross or tick:

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

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

    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.

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 (cheque/money order) to:
Clan Leslie Society of Australia & New Zealand (CLANZ)
43 Rosedale Road,
Gordon, NSW, 2072, Australia.