Please print out the following application form.
Full Name (s) Include title Mr/Mrs/Miss/etc
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________________________________________________________
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Note: Only one address per household membership. Please state names of all persons to be included in membership. State age if under 18.
Address
________________________________________________________
________________________________________________________
________________________________________________________
Postcode________________________________________________
Email Address____________________________________________
If your name is not Sutherland, Oliphant,Federith, Mowat, Cheyne, Keith or Gray please state your connection with or interest in Clan Sutherland in Scotland
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I enclose the sum of ____________in payment of the annual/life subscription rates.
Visa / Mastercard (NOT American Express)_________________________
Card Number ________________________________________________
Name on Card _______________________________________________
Expiry Date __________________________________________________
Note: rates are in £ Sterling.-

Subscription Rates	UK	Overseas
Individual Life Membership	£300	£400
Individual 1 year Membership	£15	£20
Under 18 years old, 1 Year Membership	£10	£12
Family at one Address, 1 Year Membership	£22	£28