Pilgrim Edward Doty Society Membership Application Form

Please fill in the blanks, print this page, enclose in an envelope with a check made payable to "The Pilgrim Edward Doty Society", and mail to:
The Pilgrim Edward Doty Society
c/o Mary Lee Merrill
P.O.Box 45
Warren, ME 04864

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 $10/year
  Life Membership $150 one-time fee
   Junior Membership $10 one-time fee
   Spousal Membership $10/year

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

Please send lineage information to the Doty Society Historian as an email attachment.

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

Yes       No

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