Clan Leslie Society International
Membership Application
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I hereby apply for membership in the C L S I under the provisions established by the Society.
Suffix: _____ First name:________________Middle: _____________ Surname:______________________
Address: _______________________________________________________________________________
____________________________________ City:_________________
State/Province______________________Zip/postal Code:__________________ Country:________________
Phone (include area code):_________________ OK to print in roster [ ] Not OK.[ ]
Email:____________________________________ Profession:____________________________________
DOB[M/D/YYYY]________________{Inceptors only}
[ ] I am of Scottish ancestry and a lineal descendant of Clan Leslie or a Sept of Clan Leslie.
( Septs: Abernethy, Cairney, Laing, Moore. including various spellings).
My Leslie or Sept ancestor is________________________________________who was my_______________
I am a New Member{ } Rejoining { } I am not of Lineal decent of Leslie or a Leslie Sept. { }
I certify that the above information is true to the best of my 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 application and payment to
Rebecca Chase Dobias, Secretary/Registrar
Clan Leslie Society International
P.O. Box 42
Carlyle, IL 62231-0042 USA.
Membership Dues;
[ ] Lineal (Decendant of Leslie or Sept) $21.00 US/ year.(£15.00).
[ ] Associate (non-lineal) $21.00 US/ year. (£15.00).
[ ] Inceptor (child of member) $7.50 US, (£4.00) One time fee to age 18.
[ ] Life Membership $500 U.S (£360).
Inceptor sponsor name: Last_________________ First___________ Middle _____________
City, State/Provence, Country _________________________________________________________
_________________________________________________________
If resident in the UK or Europe you have the option to send your membership form and fee to:
Family Group Sheet
Please fill in this sheet with as much information you can.
Your name______________________________ Dob.__________________Where _________________________
Your brothers____________________________Dob__________________ Where_________________________
Your sisters_____________________________ Dob___________________Where_________________________
Your father_____________________________ Dob___________________Where_________________________
Your mother____________________________ Dob___________________Where_________________________
Your Grandfather________________________Dob___________________Where_________________________
Your Grandmother_______________________Dob___________________Where_________________________
Any other relevant information
By filling in this sheet it will give the society a chance to link you with possible relatives.
Thank you for taking the time to Join the CLSI and for filling in this form.
B Lesslie
4 Albany Terr
Perth PH1 2BD
01738 563050
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