The Clan Cian Membership Application & Receipt Form

The Three columbines represent the three old kingdoms

Eile / Ormonde
Family Septs
Clan Cian Services^.
19221 Condor Way^.
Cottonwood, Ca. 96022 USA
Phone: 530-347-9603
Fax: 530-347-0246
Secondery Address: P.O. Box 1035 Ceres, Ca. 95307

Membership Application & Receipt

Name of Applicant: ^.
Street Address: ^.
City: State: Zip: ^.
Phone: () - Place of Birth: ^.
Email: ^. (required)
Application Date: Chief Eile's Final Approval:                      ^.
List Paternal or Maternal Septname for Clan Affiliation
Septname: Received Packet: ^.
Chieftain or Officer Accepting Application: ^.
Game/Activity or Internet: ^.
Life Membership: $80.00                      Paid By: ^.
Type of Card: ^.
Card # Exp Date: / ^.
Name on Card: ^.
Signature:                                                                                                           ^.
White & Yellow to Liam / Pink to Clan Tent / Goldenrod to Member ^.