Mother Lode Scots
Membership & Dues

Please fill in the blanks, using your tab key to move between fields.

 

First Name Last Name
Address
CityState ..Zip
Phone Email
Date of Birth
Clan(s)

Additional Family Members
Please list first & last names
of each person,
clan and date of birth,
one name per line



Membership Selection and Dues

Indicate Number of Memberships & Badges Junior.......................$10.00
Individual................$20.00
Family......................$30.00
Name Badge..........$15.00




To process your membership press Submit