Clay Family Society

MEMBERSHIP   REGISTRATION  FORM

Primary Member_______________________________________________________________________

Second Member________________________________________________________________________

Other Family Members under 18___________________________________________________________

Mailing Address_______________________________________________________________________

City__________________________________________ State___________________ Zip____________

Phone #_______________________________________ 

Email________________________________________________________________________________

Membership type ___________ Single $30.00 ( 1 vote, 1 subscription)

                              ____________ Family $35.00 (2 votes, 1 subscription)

Check number___________________________

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Please include a short statement of your Clay Lineage or interests.

We plan to publish a Membership directory, if you do not want
your mailing or email address published, check here______________

Please make checks payable to Clay Family Society and send to

Constance Collins

Clay Family Society

3800  Fairfax Dr. Apt. #408

Arlington, Va. 22203