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Curtin Clan Membership Application
Membership dues to the Clan Association are $30 US per year. For our non-US cousins,
you will have to make an international money order.
Please, make only one membership per family.
First Name _____________________Middle Initial ___ Last Name ___________________
Address ______________________ City ___________________
State/Province/County ____________________________ Country __________________
Postal Code ___________________ Email address _______________________________
Telephone: _______________________________________________________________
The following Questions are to help find your place in the Curtin Clan
Do you know what county in Ireland is your family is from? _________________________
Fathers Name _______________ Date of Birth ______ Place of birth ____________
Mothers maiden Name _________Date of Birth __________Place of birth ____________
Marriage Date and Location ________________________________________________
Paternal Grandfather's Name _______________________________________________
Date of Birth ______ ___ Place of Birth _________________________________
Paternal Grandmother's Name _______________________________________________
Date of Birth _____ ____ Place of Birth _________________________________
Marriage date and location __________________________________________________
Maternal Grandfather's Name ________________________________________________
Date of Birth ______ ____ Place of Birth _________________________________
Maternal Grandmother's Name_______________________________________________
Date of Birth ______ ____ Place of Birth __________________________________
Marriage Date and Location _________________________________________________