Name:_________________________________________________

Address:_______________________________________________

City:_______________    State:______    Zip Code:_____________

Telephone:_____________________________________________

Email:__________________________________________________

Affiliated Clan Surname:_____________________________________

Please check one:

(  ) Membership- Individual or Family:-----------------------------------------------$20
(  ) Contributing Membership-----------------------------------------------------------$30 or $50
(  ) Life Membership---------------------------------------------------------------------$300
(  ) Associate Membership (Interested Non-Farquharsons)--------------------$20

Spouse/Family members:_____________________________________

Name(s) as you would like it to appear on the Membership Certificate:
___________________________________________________________________

Please print out and send the completed form and payment to 

Clan Farquharson, USA
3209 Dave Wilson Rd
Harleton, TX 75651