Membership Application

Clan Grant Society USA Membership Application

Creation Date

Month

Day

Year

Renewal Status *

New

Renewal

Member Id

Membership Type *

Individual

Family

Member Info

Date of Birth *

Title

First *

M.I.

Last *

Suffix

Nickname

Address *

Address_2

City *

State/Prov. *

Zip/Postal Code *

Country *

Home Phone *

Mobile Phone

Email *

Comment 1

NOTE: Individual application only. 2nd Adult details not shown.

Please proceed down the form to select your type of membership.

2nd Adult

Date of Birth

Title

First

M.I.

Last

Suffix

Separator 1

Individual Membership List

Individual Membership (1 Year) , Price: $20.00

Individual Membership (2 Year), Price: $40.00

Individual Membership (3 Years), Price: $55.00

Individual Membership (Lifetime), Price: $400.00

Family Membership List

Family Membership (1 Year), Price: $35.00

Family Membership (2 Year), Price: $70.00

Family Membership (3 Year), Price: $100.00

Family Membership (Lifetime), Price: $700.00

Separator 3

Donations

Donation: Clan Grant Centre Fund - ($10 increments) Quantity: Clan Grant Centre Fund, Price: $10

Allows donation in $10 increments.

Donation: Scholarship Fund - ($10 increments) Quantity: Scholarship Fund, Price: $10

Allows donation in $10 increments.

Leave this field blank