| Full Name
of Candidate____________________________________________________
Maiden Name
___________________________________________________________
(if applicable)
Address _______________________________________________________________
________________________________________________________________
(Please include ZIP+4 code)
Daytime Phone_____________________________ Email Address _________________
Home Phone (if different)
_________________________________________________
Occupation
____________________________________________________________
Name of Mayflower Ancestor (s)
___________________________________________
Name(s) of any relative(s) who are/were members of the
Mayflower Society in New York or any other State Society.
Please include General and State numbers and a copy of their approved application,
if available.
________________________________________________________________________
________________________________________________________________________
Please
include a check for $125 for the application fee. The application fee is not refundable if the line is rejected, the application is rejected,
or if the applicant fails to complete the documentation.
Signature ____________________________________ Date
Submitted ___________
|