Preliminary Membership Application

Preliminary Membership Application

Myles Standish Society

Susan Abanor

14 West 17th Street

New York , NY 10011

[email protected]

 

or

 

Edward Myles Standish

218 Tolland Tpke

Willington, CT 06279

[email protected]

 

PRELIMINARY MEMBERSHIP APPLICATION

 

 

Date _____________________________

 

Applicant (print) ____________________________________Date of Birth __________

 

Signature of Applicant _______________________________

 

Spouse (if applicable) ________________________________Date of Birth __________

 

Add my spouse once I am accepted (application fee is waved)  ____Yes  ____ No

 

Residence _______________________________________________________________

 

________________________________________________________________________

 

Seasonal Residence (place indicated dates) _____________________________________

 

________________________________________________________________________

 

 

Telephone Number _____________________ E-mail address ______________________

 

Occupation ______________________________________________________________

 

How did you learn about the Hopkins Heritage?

 

·        Relative (Name) ______________________________________________

·        Another Society (name) ________________________________________

·        Mayflower Quarterly __________________________________________

·        Other (please explain) _________________________________________

 

Please return this Preliminary Application and Synopsis of your Hopkins Descent Line to the above address.