|

Please print out the following application form. Full Name (s) Include title Mr/Mrs/Miss/etc ________________________________________________________ ________________________________________________________ ________________________________________________________ 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 ________________________________________________________ ________________________________________________________
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 | |