Supplemental Application – Mayflower Society of New York

Date:
MM slash DD slash YYYY
Applicant's Name*
Maiden Name: (if applicable)
Street Address:*
City
State
Zip Code
Home Phone or Cell #*
Email Address*
Occupation*
Name of Mayflower Ancestor(s)*
Names of Relatives who were/are Members, GS & State #'s of the Mayflower Society in New York or any other Society. This information will be helpful in filling out your lineage from, but is not required.*
Names of Relatives who were/are Members, GS & State #'s of the Mayflower Society in New York or any other Society. This information will be helpful in filling out your lineage from, but is not required.
Signature
Signature
Date of Sumittal
Date of Sumittal
Please include $150.00 payment 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.

Complete the form, print and mail to:
The Society of Mayflower Descendants in the State of NY

20 West 44th Street

New York, NY 10036-6603
Phone
This field is for validation purposes and should be left unchanged.

After submitting your form, please proceed with $150 payment for the application fee below.

The application fee is non-refundable if the line is rejected, the application is rejected, or if the application fails to complete the documentation.

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Adult Supplemental Application
$150.00

After submitting your form, please proceed with $150 payment for the application fee below.

Adult Supplemental Application