Clan Cameron - Stone Mountain, GA.

"WARNING" Do Not Try To Email This Form. It Won't Work! (YET!)

Dues must be paid every october

MEMBERSHIP

Dues: Individual or Family $20.00(Children under 21 included)

Questions that have a * following the question are required to be answered.

New member:
Renewal:
Gift Membership:

Date: *

Mr. Mrs. Miss: *

Name: *

Last Name: *

Spouse's name:

Address: *

Address#2:

City: *

State: AKALARAZCACOCTDCDEFLGAHIIDILINIOKSKYLANCNDNENHNJNMNVNYMAMDMIMNMOMSMTOKOHORPARISCSDTNTXUTVAVTWAWVWIWY*

Zip code: *

Phone numbers:
Home: *
Work:
FAX:
Cell phone:
Beeper number:

(If don't have an email address, please put "Don't have one" in the 2 boxes below.)

Email address: *

Repeat email
address: *

Occupation:

Spouse's
occupation:

Additional people that you want a membership card for:

Special skills or talent:

Previous Clan Cameron Affiliation:

Previous Clan Affiliation(s):

Will/do you participate in a Clan Committee?: YES NO

Do you attend (or did you attend) Clan meetings ?: YES NO

List of other things that you could offer to Clan Cameron:

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Stone Mountain, GA.