Clan MacBean ,Inc.

Suite 213, 441 Wadsworth Blvd.

Membership Application

NAME:__________________________________________________________

ADDRESS:_______________________________________________________

CITY:___________________________

STATE/PROVINCE:__________________________

ZIP+4/POSTAL CODE:___________________________

COUNTRY:_______________________

PHONE:_________________________

DUES: $25.00 ($28.75 Canada) per year;

$60 ($69.00 Canada) for 3 years;

$360 ($414. Canada) Life Membership.

Enclosed Amount:___________________________

If Genealogical Family # is known:__________________________

Please list other family members living at your address:_________________________________________________________

_______________________________________________________________________________________________________

OCCUPATION (If retired, former occupation):______________________________________________________________

_______________________________________________________________________________________________________

HOBBIES:_____________________________________________________________________________________________

_______________________________________________________________________________________________________

Prices Effective Jan. 2007 From the Clan Web Page