Mother Lode Scots
Membership Application

Membership is open to anyone interested in the rich and historic traditions of Scotland

ANNUAL DUES:
ADULT
$17.50
 
JUNIOR
$7.50
 
FAMILY
$27.50

A ONE TIME FEE OF $10.00 PER PERSON IS REQUIRED TO OFFSET THE COST OF MEMBER BADGES


Date________________________________________

Name ________________________________________________________________________ Spouse __________________________________________________________________________________
Your Birthdate ___________________________________ Spouse Birthdate ________________________________________ Anniversary ________________________________________
Children (name & birthdate) ______________________________ _____________
______________________________ _____________
______________________________ _____________
______________________________ _____________

Address __________________________________________________________________________________________________

Address __________________________________________________________________________________________________

City _________________________________________________________________________________ State _____________ Zip ______________--____________
Phone (__________) ________________________________ Email _____________________________________________________________________________________

Clan(s) ___________________________________________________________________________________________________

Signature__________________________________________________________________________________________________

Make check payable to
Mother Lode Scots
P.O. Box 45
Pine Grove, CA 95665-0045

Please complete the following survey
Check all that apply

What aspects of Scottish/Celtic Culture/Heritage interests you?
  Genealogy
Language
Food
Highland Games
Bagpipes
 
Scottish History
Literature
Scottish/Irish Cooking
Athletics
Music
 
Military History
Travel
Crafts
Dancing
 
 
Re-enactments
Folklore
Teach any of above
Scottish Country Dancing
 
Other ________________________________________________
Other ________________________________________________
Would you be interested in serving on a committee?
 
Burns Supper
Kirkin' O' The Tartan
Annual Bar-B-Q
 
Annual Tea
Fund Raising
Publicity
 
Membership
Help set up at events
Other ____________________________________________

Please list any specials skills that you would be willing to share

________________________________________________________________ ________________________________________________________________
________________________________________________________________ ________________________________________________________________

Name (Please Print) ___________________________________________________________________________________