C L A N   L O C K H A R T


  'Corda serrata Pando'                                            Chief
(I open hearts locked up)                                   Angus H.M. Lockhart
                                                                 of the Lee

                            MEMBERSHIP APPLICATION


Name    ________________________________________________  Birthdate ____________
Address ________________________________________________________________________
City    ________________________________________ State _______  Zip ____________
EMail   ________________________________ Ok to list in EMail directory _________
Phone   _________________________ (so we can contact you if there are questions)

Spouse  ________________________________________________  Birthdate ____________

Dependent
 Children ______________________________________________  Birthdate ____________
          ______________________________________________  Birthdate ____________
          ______________________________________________  Birthdate ____________
          ______________________________________________  Birthdate ____________

Blood Relationship to Clan _____________________________________________________
Immigrant Ancestor(if known) ___________________________________________________
From where in Scotland __________________ Port of Embarcation __________________
Ship __________________________ Year ____ Port of Entry ________________________
Settled Where __________________________________________________________________

Particular Interest of Each Family Member:
Piping   _______________________________  Highland Dancing _____________________
Athletics ______________________________  Genealogy ____________________________
History  _______________________________  Scottish Country Dance _______________
Other __________________________________  Scottish Military History ____________


Please complete the Ancestral Chart as well as you are able.

                                         Family Membership -  $15.00/year
                                         Outside of USA    -  $17.00/year
                                         Life Membership   - $250.00


                                         Send Application and Dues payable to:
Signature _____________________________       Clan Lockhart, Inc.
                                              James L. Lockhart
Date      _____________                       703 Eleanor Ave.
                                              New Smyrna Beach, FL 32168

If you are Sponsored by an current Clan Lockhart member, list name below:

Sponsoring member's name: _________________________________________________


Member:
Council of Scottish Clans and Associations, Inc.




                              Skeletal Ancestral Chart

Fill in as much information                                       ________________
as you can.                                                      / G-G-GrandFather
                                                  _______________/
                                                 /G-GrandFather  \
                                                 |Born           \________________
                                                 |Died             G-G-GrandMother
                                   ______________/
                                  /GrandFather   \Marriage:
                                  |Born:         |                ________________
                                  |Where         |               / G-G-GrandFather
                                  |Died:         \_______________/
                                  |Where          G-GrandMother  \
                                  |               Born           \________________
                                  |               Died             G-G-GrandMother
                 _________________/
                /Father's Name    \Marriage:                      ________________
                |Born:            |                              / G-G-GrandFather
                |Where            |               _______________/
                |Died:            |              /G-GrandFather  \
                |Where            |              |Born           \________________
                |                 |              |Died             G-G-GrandMother
                |                 \______________/
                |                  GrandMother   \Marriage:
                |                  Born:         |                ________________
                |                  Where         |               / G-G-GrandFather
                |                  Died:         \_______________/
                |                  Where          G-GrandMother  \
                |                                 Born           \________________
                |                                 Died             G-G-GrandMother
________________/ 
                \ Marriage:
Name            |                                                 ________________
Born:           |                                                / G-G-GrandFather
Where           |                                 _______________/
Died:           |                                /G-GrandFather  \
Where           |                                |Born           \________________
                |                                |Died             G-G-GrandMother
                |                  ______________/
                |                 /GrandFather   \Marriage:
                |                 |Born:         |                ________________
                |                 |where         |               / G-G-GrandFather
______________  |                 |Died:         \_______________/
                |                 |Where          G-GrandMother  \
Spouse's Name   |                 |               Born           \________________
                |                 |               Died             G-G-GrandMother
                \_________________/
                 Mother's Name    \ Marriage:                     ________________
                 Born:            |                              / G-G-GrandFather
                 Where            |               _______________/
                 Died:            |              /G-GrandFather  \
                 Where            |              |Born           \________________
                                  |              |Died             G-G-GrandMother
                                  \______________/
                                   GrandMother   \Marriage:
                                   Born:         |                ________________
                                   Where         |               / G-G-GrandFather
                                   Died:         \_______________/
                                   Where          G-GrandMother  \
                                                  Born           \________________
                                                  Died             G-G-GrandMother