ChicagoScots · 2024 Membership Form

I would like to purchase a Membership for myself	Quantity
$1,000 - Life Membership
$100 - Family Membership
$60 - Individual Membership

I would like to buy a Membership as a Gift	Quantity
$1,000 - Life Membership
$500 - Life Membership- For Immediate Family members ONLY with a purchase of/or existing Life Membership
$100 - Family Membership - Gift
$60 - Individual Membership

Contact Information

Name

*

First Name

Last Name

Spouse/Partner Name for the Membership

First Name

Last Name

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Scottish Clan

Birthday

(mm/dd/yyyy)

Please list children (under 18) and date of birth to be added to your membership

Gift Information

Name for Individual Membership Gift

*

First Name

Last Name

Where should we mail details about your individual membership gift?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Individual Gift?

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Individual Membership Gift #2

*

First Name

Last Name

Where should we mail details about your individual membership gift #2?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Individual Gift #2?

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Individual Membership Gift #3

*

First Name

Last Name

Where should we mail details about your individual membership gift #3?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Individual Gift #3?

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Individual Membership Gift #4

*

First Name

Last Name

Where should we mail details about your individual membership gift #4?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Individual Gift #4?

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Life Member Gift

*

First Name

Last Name

Where should we mail details about your life member gift?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member - Family

*

First Name

Last Name

Where should we mail details about your life member gift? -Family

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift - Family

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member - Family #2

*

First Name

Last Name

Where should we mail details about your life member gift? -Family #2

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift - Family #2

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member - Family #3

*

First Name

Last Name

Where should we mail details about your life member gift? -Family #3

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift - Family #3

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member - Family #4

*

First Name

Last Name

Where should we mail details about your life member gift? -Family #4

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift - Family #4

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member #2

First Name

Last Name

Where should we mail details about your life member gift #2?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift #2

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member #3

First Name

Last Name

Where should we mail details about your life member gift #3?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift #3

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Gift- Life Member #4

First Name

Last Name

Where should we mail details about your life member gift #4?

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Life gift #4

*

Please provide an email for the person who will receive your gift membership

Verify Email

*

Name for Family Gift

First Name

Last Name

Spouse Name for Family Gift

First Name

Last Name

Address for Family Gift

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Family Membership Gift

Verify Email

Please enter children (under 18) & birthday to be included in your Family Membership Gift

Name for Family Gift #2

First Name

Last Name

Spouse Name for Family Gift #2

First Name

Last Name

Address for Family Gift #2

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Family Membership Gift #2

Verify Email

Please enter children (under 18) & birthday to be included in your Family Membership Gift #2

Name for Family Gift #3

First Name

Last Name

Spouse Name for Family Gift #3

First Name

Last Name

Address for Family Gift #3

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Family Membership Gift #3

Verify Email

Please enter children (under 18) & birthday to be included in your Family Membership Gift #3

Name for Family Gift #4

First Name

Last Name

Spouse Name for Family Gift #4

First Name

Last Name

Address for Family Gift #4

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email for Family Membership Gift #4

Verify Email

Please enter children (under 18) & birthday to be included in your Family Membership Gift #4