CFSNA Membership Application Form Patron

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Clan Ferguson Society of North America

Membership Application

Patron Member

Forty Years of Cumulative Active Membership Required

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Are you eligible?

Eligibility for Patron Membership status requires forty cumulative years of active membership. Acitive membership is defined as "dues paid". The years of active membership do not have to be consecutive. Gaps in membership are permitted. The key is the TOTAL number of years of active membership.

Use the formulas below to dertermine your eligibility. (Entries in these fields are required).
J = Date Joined CFSNA*
R = Date Patron Status Requested*
N (Number of membership years not counting gaps in membership, if any) = J - R*
G = Gaps in Membership (number of years in a non-paying status)*
A (Total active membership years; must equal 40 years or greater to qualify) = N - G*
Full name including middle name or initial*

First and MiddleLastSuffix
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone Number*

Area CodePhone Number
Telephone Number (Cell)

Area CodePhone Number
Membership Number*
E-mail*

Confirmation Email
Birth Date*

MonthDayYear
Current Photo

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Place of Birth (city, state or province)*
Occupation
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Comments/Questions?
Your application for Patron Membership status will be reviewed by the Executive Committee of the CFSNA. You will be contacted as soon as a determination has been made concerning your eligibility.
Signature (typed)*
Date*
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