The Clan Brodie of the America's

I wish to become a member of the Clan Brodie and enclose subscription for:

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Membership Dues	Clan Member, Yearly $0.00 Clan Associate, Yearly $0.00 Steward, Yearly $25 Steward, 10 Year $100 Patron I $100 Patron II $200 Patron III $300 Benefactor $500
First Name	Last Name
Address #1
Address #2
City	State Zip
Country
E-Mail Address (needed)
Telephone (optional)

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Grounds on which you claim membership of the Clan (please check):

Are (or was) named or have the name Brodie related to a Brodie other, please explain below

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Please state below the names and addresses of any relatives or friends who may be eligible for membership, and who may be approached by the society.

-Printable Version-

A link to PayPal is next. Otherwise, subscriptions should be made payable to Clan Brodie of the Americas
remit to: C.B.A.; 6942 East Calle Centuri; Tucson, Arizona; United States of America; 85709-5424