Pilgrim Edward Doty Society Membership Application Form

Please fill in the blanks, print this page, enclosein an envelope with a check made payable to "The Pilgrim Edward DotySociety", and mail to:
The Pilgrim Edward Doty Society
c/o Linda Spencer
23 Evergreen Terrace
Seymour, CT 06483

First Name     Last Name

Street Address

City     State or Province

Zip or Postal Code     Country, if not U.S.

Home Telephone      E-mail

Select one of the following options:

Regular Membership $15/year
   Junior Membership $15 one-time fee

How did you hear about the Pilgrim Edward Doty Society?

  Internet Search Engine
  From a friend or family member
   Through a genealogical organization
   Other 

If you believe that you are related to Edward Doty, from which of his children are you descendant?

Edward    John    Thomas    Samuel    Desire      Isaac   Joseph     Mary

If you wish to include Lineage Information with your application, you must use this form and send it along
with your application form to the address above.

If you are a woman, was your maiden name Doty?

Yes       No

______________________________________________________________________________________

If you would like a membership brochure sent to a friend or relative, pleaseprovide their name and address: