SMDPA - SMDPA Proposal for Membership

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SMDPA Proposal for Membership

This is an on-line proposal submission form.

* Date of Application

Prefix Mr., Mrs., Ms., Dr., Rev., Other

* First Name

* Last Name

Suffix Sr., Jr., III, MD, PhD., Other

* Date of Birth

Address

City

State

Zip

* Primary Email

Alternate Email

Home Phone

Cell Phone

Mayflower Lineage

Please list the Line Carrier (Son/ Daughter) and the Spouse of each. Please note that your name should be last
(ie) Son: John Quincy Adams; Spouse: Louisa Adams

Name the Line Carrier and Spouse of each Please use the SMDPA FULL Mayflower Information application form.

Please complete and submit the SMDPA Proposal form first. The SMDPA Mayflower Full application form may be sent separately to smdpa-historian via email and the SMDPA Full form is located here.

Marital Status (if applicable)

Full Name of Spouse

Full Maiden Name If different from above

SUPPLEMENTAL / TRANSFER MEMBER INFORMATION

* Is this inquiry a Supplemental?

* Are you a transferring member of another State Society?

Name of State

Your GSMD Member #

Your State Member #

Membership Inquiry

* Do you have a relative in any state Mayflower Society?

Full Name of Relative if answered Yes above

Relationship to you

Relative’s GSMD Member #

Relative’s State Member #

Membership Category

* Indicate the category you are seeking

How did you learn of the Society? (General Society, Member, Sail 1620 web site, Brochure, press/publicity, other)