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Clan Henderson Society of Canada

306 -5475 Inglis St. Halifax, NS B3H 1J6

Membership Application

Please type in your information on this form, print it and send it to the Clan Henderson Secretary at the above address with your cheque in the amount of $15.00.


Membership in the Clan Henderson Society of Canada is based upon the family, which includes the Henderson or Descendant and Spouse as well as all children under 18 years of age. Please provide this information in the space below with the Henderson in the first position. Please provide information on your grown children on the back of this form.


Membership is also open to "Henderson by affection", non Hendersons who want to support Scottish culture in Canada.

Name: Date of Birth:

Spouse: Date of Birth:

Child 1: Date of Birth:

Child 2: Date of Birth:

Address:

Home Phone:
Work Phone:
Cell Phone:
Postal Code:

Email address:

I am the lineal descendant of who was or is believed to be of Scottish Ancestry.

I am related to Clan Henderson member,

Profession / Occupation / Special Talents



I am willing to participate in (check all that apply):
Games "&" Festivals
Social Functions
Clan Offical
Newsletter Material
Do not wish to participate in activities at this time.

I wish to recieve the Newsletter:
Post
via Internet

All pesonal information collected here will be kept confidental by the Clan Henderson Society, and will not be shared or sold.