Membership Form of Clan Leslie Society of Australia and New Zealand

(Kindly complete the following information for our records)

Surname:

First Name:

Middle Name(s)

Street Address:

Suburb/Town &
Post Code:

State:

Country:

Telephone Number
plus Area Code:

Email Address:

Date of Birth:

Occupation:

Please indicate by cross or tick:

[   ] I am of Scottish ancestry and a lineal descendant of Clan Leslie, or a Sept of Clan Leslie in Scotland.

(Please circle Sept where applicable & allow for various spellings)

Septs:     Abernethy,     Bartholomew,     Cairney,     Laing,          More.

My Leslie or Sept ancestor is/was:________________________________________________________

who is/was my (state relationship to you):__________________________________________________

[   ] I am not a lineal descendant of Clan Leslie or its Septs. (Associate Membership)
[   ] I'm a New Member.                                                                 [   ] I'm Rejoining.

Membership Fees are: AU$25.00 per annum.

I hereby apply for membership in the Clan Leslie Society, under the provisions established by the Chief of the Clan.
I certify that the above information is true to my best 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.

Surname:
First Name:
Middle Name(s)
Street Address:
Suburb/Town & Post Code:
State:
Country:
Telephone Number plus Area Code:
Email Address:
Date of Birth:
Occupation: