Clan Leslie Society International       Membership Application
	I hereby apply for membership in the Clan Leslie Society under the provisions established   by the Chief of the Clan. Surname: ____________________ First: _____________         Middle: __________________        Suffix:______ Address: ____________________________________               ____________________________________  City:___________ State/Province________________________ Zip/postal Code: Country:___________________ Phone (include area code):_________________  [  ]Ok to print in roster [  ] Not Ok.                                                                                    Fax(include area code)______________________    Email:___________________ Profession:__________________________                D.O.B (M/D/YYYY)___________ [  ] I am of Scottish ancestry and a lineal descendant of Clan Leslie or a Sept of        Clan Leslie. (For Septs see Website) My Leslie or Sept ancestor is/was _______________ my_____________ [  ] I am not of lineal descent of Clan Leslie or its Septs. (Associate Membership) [  ] New Member   [  ] Rejoining 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            Leslie K Seich   CLSI  P.O. Box 845,  Jackson, NJ. 08527  USA.     Membership Dues; [  ] Lineal  (Desendant of Leslie or Sept) $21.00 US/ year. [  ] Associate (non-lineal) $21.00 US/ year. [  ] Inceptor (child of  member) $5.00 US, One time fee to age 21.   Inceptor sponsor name:  Last_____________        First___________   Middle _____________                 City, State/Provence, Country ______________________________________