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Membership
Application: Clan Johnston/e Assn. N.Z. INC.
PLEASE PRINT.
Surname:
……………………………………………… (Mr/ Mrs/ Ms/ Miss)
DATE………………………………
First/preferred
name(s):………………………………….……………………...........……….
Address:……………………………………….………………………………………...................
………………………………………..……………………………………..................................
…………………………………………………………………..Post Code…………….................
Telephone:
(Home) 0…..………………..…………....……...... or Mobile
0…………………………………….............
e-mail…….…………………………………..……………………….....................
Occupation:
………………………………………….........Partner/Spouse name: …………………………………............
Signature:
………………………………………………………………………………
The Annual membership fee is $20.00 or $85.00 for 5 yrs.
The
financial year ends 31 March each year
| Donation | $……………. | |||
| Clan badge | $10.00 | Yes / No | ||
| Clan Handbook | $5.00 | Yes / No | ||
| – | These are optional | |||
| Jacket Crest | $10.00 | Yes / No | TOTAL $………………… is enclosed | |
| A/C #38-9008-0307964-00 |
Please
forward to: Clan Johnston/e Assn. NZ .INC.
14
Waikura Terrace,
Taumarunui. 3924
Optional Information
for Clan Archives:
A
short account of my Johnston/e family connections is as follows: First arrival
in Australia/New Zealand:
Name
of ancestors:
……………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………..
............................................................................................................................................................
Ship/Port:…………………………………………………….....................Date:……………………………………………………
I
could be interested in the following Clan activities:
Informal
social gatherings ( )
Genealogy
( )
Clan history ( )