Clan MacNeil in Canada

                                   APPLICATION FOR MEMBERSHIP

If paying between August 1^st and March 1^st:

           [  ]  Family and single membership $25           [  ]  Senior (65+) membership $20

 If paying between March 2^nd & July 31^st:

         [  ]  Family and single membership $12              [  ]  Senior(65+) membership  $10

  Please note that U.S. & International members pay in U.S. funds

             NAME--------------------------------------------------------------------------------------------------------

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             PHONE------------------------------                         E-MAIL ADDRESS----------------------------

      Names of family members to be included in membership-----------------------------------------------------------

                       SIGNATURE ------------------------------------------------- DATE----------------------------------------

           Please use the back of this form to list any items of interest that relate to your wish to join.

              Enclosed is my payment of $_______        for [  ] one year or [  ] 6 months membership.

Please forward to:    

ALENE McNEILL, President.

378 Ashworth Dr.

Newmarket, On.  L3Y 6T6

alene.mcneill@sympatico.ca