
Name (Please print): _________________________________________________
Address (Please print): _______________________________________________
__________________________________________ E-Mail _________________
What is your ethnic heritage and your interest in the Scotch-Irish Society of the USA?:
Signature: ___________________________ Date:__________
Proposed by:*___________________ Seconded by: ___________________
Approved by: ________________________
* You may propose and second yourself. If you know one or more current members, ask them to propose and second you.
Application fee: $15.00 (non-refundable) Annual dues: $20.00 Total:
$35.00