Clan Leslie Society International
Membership Application
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I hereby apply for membership in the C. L. S. I. under the provisions established by the Chief of the Clan.
Surname: ____________________
First: _____________ Middle: __________________ Suffix:______
Address: ____________________________________
____________________________________ City:___________
State/Province________________________ Zip/postal Code: Country:___________________
Phone (include area code):_________________ [ ]Ok to print in roster [ ] Not Ok.
Fax(include area code)______________________ Email:___________________
Profession:__________________________ D.O.B (M/D/YYYY)___________
[ ] I am of Scottish ancestry and a lineal descendant of Clan Leslie or a Sept of
Clan Leslie. (For Septs see Website)
My Leslie or Sept ancestor is/was _______________ my_____________
[ ] I am not of lineal descent of Clan Leslie or its Septs. (Associate Membership)
[ ] New Member [ ] Rejoining
I certify that the above information is true to the best of my knowledge and belief.
I declare that if accepted for membership, I will observe the rules and regulations
of the Society and will promote its welfare to the best of my ability.
Signature:______________________________ Date:________________________
Please send application and payment to
Rebecca Chase Dobias
Secretary/Registrar
Clan Leslie Society International
P.O. Box 42
Carlyle, IL 62231-0042.
USA.
Membership Dues;
[ ] Lineal (Desendant of Leslie or Sept) $21.00 US/ year.(£15.00).
[ ] Associate (non-lineal) $21.00 US/ year. (£15.00).
[ ] Inceptor (child of member) $5.00 US, (£3.00) One time fee to age 21.
Inceptor sponsor name: Last_____________ First___________ Middle _____________
City, State/Provence, Country ______________________________________
Family Group Sheet
Please fill in this sheet with as much information you can.
Your name______________________________ Dob.__________________Where _________________________
Your brothers____________________________Dob__________________ Where_________________________
Your sisters_____________________________ Dob___________________Where_________________________
Your father_____________________________ Dob___________________Where_________________________
Your mother____________________________ Dob___________________Where_________________________
Your Grandfather________________________Dob___________________Where_________________________
Your Grandmother_______________________Dob___________________Where_________________________
Any other relevant information
By filling in this sheet it will give the society a chance to link you with possible relatives.
Thank you for taking the time to Join the CLSI and for filling in this form.
Send your form and fee to Uk Convener
B Lesslie
4 Albany Terr
Perth PH1 2BD
01738 563050
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