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The Ulster-Scots Society of America
Membership Application Form


Please check membership category:

Individual:      _____

Family:          _____  (List spouse's name also)

New Member: _____

Renewal:        _____

Annual membership dues: Individual: $15, Family: $20 (upon the initial dues payment, dues are payable in January of each year)

EMAIL:  _______________________________________________________

TELEPHONE: __________________________________________________

FULL NAME:  __________________________________________________

COMPLETE ADDRESS: _________________________________________

                                    _________________________________________

                                    _________________________________________

I am interested in volunteering for the following committees and activities:

Membership       _____

Publicity             _____

Newsletter          _____

Special Events    _____

Social Activities  _____

Web Page          _____

Education           _____

Historian             _____

Area Convener     _____

Note: Information on the locations/dates/times of various scheduled membership meetings and gatherings in each particular locale (and the contact info for the nearest coordinating Area Convener) will be communicated to the membership on a regular basis. Completed applications and attached dues payments can be mailed to: The Ulster-Scots Society of America, PO Box 724, Matthews, NC, 28106-0724.  For more information contact Paul Smallwood (President, Ulster-Scots Society Of America) at email:  ulstermen@yahoo.com or telephone 919-380-0383.  Alsor Diane Campbell (Membership Secretary) at email: decmpbl@carolina.rr.com.  

___________________________________________________________________________

Signature/Date


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