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Clan Johnston/e of New Zealand

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E-MAIL FAMILY HISTORY CLAN INFORMATION The Clan Johnston Shoppe

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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:……………………………………….………………………………………...................

 

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…………………………………………………………………..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:

……………………………………………………………………………………………………………………………………….

 

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Ship/Port:…………………………………………………….....................Date:……………………………………………………

I could be interested in the following Clan activities:

Informal social gatherings    (  )                  Genealogy                          (  )                 

 Clan history                      (   )

 

Privacy Act 1993: Information provided will be used for Clan purposes only, and will not be provided to any other organisation or individual