Society of Mayflower Descendants in the

State of Utah

Junior Member Application Form

Instructions:  Fill out the form directly on your computer screen.  Then print this page, and mail it to our Junior Member Chair at the address below.  Keep a copy of this form for your records.

Rachelle Orton, Junior Member Chair

Utah Society of Mayflower Descendants

1035 Canyon Drive

Spanish Fork, Utah  84660

801-798-1980

, a member of the Society of Mayflower

Descendants in the State of Utah (General No. State No. ) hereby applies for junior membership in the Society for

by right of (his/her) descent from who was a passenger on the Mayflower voyage that terminated at Plymouth, New England, December 1620.

Signature of Sponsor:  

Relationship of sponsor to junior member candidate:

Date of application:    $5.00 membership fee enclosed

A letter and certificate will be mailed to the junior member upon receipt of the $5.00 fee.

Birthday of junior member candidate:  Year Month Day

Address: City:  State:   Zip:

Name of parent who carries lineage descent of above indicated Mayflower passenger:

Phone: Email:

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