THE AVERY MEMORIAL ASSOCIATION

Groton, CT

MEMBERSHIP APPLICATION

Please print all information clearly.

NAME: [ ] Mr. [ ] Mrs. [ ] Miss [ ] Ms._____
STREET ADDRESS: _
CITY: STATE: ZIP CODE:_
TELEPHONE NUMBER: _______
E-MAIL ADDRESS: _
Would you like your newsletter sent by E-Mail? [] Yes [] No
Choice of Dues: [] Annual Individual (adult descendant or spouse).........$25. [] Annual Family (same household).................................$35. [] Life Individual.......................a one-time payment of $500.
The membership year is July 1 to June 30. Dues are due on July 1st and are payable in U.S. Dollars only. Donations of money or materials to the Association are deductible, within legal limits, for Federal tax purposes, and are very much appreciated.
Membership Categories (check one):
[] Friend of The Avery Memorial Association - Fill in the above information ONLY . Members in this category cannot establish a genealogical connection to James Avery (1621 - 1700), but will have the same rights and benefits as those of proven James Avery descendants.
[] Active Member (Descendant of Christopher Avery) - Fill in the above information AND the rest of this application. My ancestry is from one of the children of James Avery (1621 - 1700), son of Christopher Avery, who setled in Groton, CT circa 1650, of which I can prove bloodline descent, as demonstrated in the attached genealogy.
Please make your check payable to "The Avery Memorial Association." Send Application and dues to: The Avery Memorial Association P. O. Box 7245 Groton, CT 06340-7245

DIRECTIONS FOR COMPLETING YOUR "DESCENDANT" APPLICATION

Please trace your lineage starting with yourself. Then enter in the next space the Avery descendant, Father or Mother as the case may be. The Groton Avery Clan (1912) geneaology may provide you with much of your complete line, and, if so, place the assigned genealogy number opposite the respective ancestor. Once your line is traced to an ancestor in the book, no further documentation will be needed. If you need further assistance, we may be able to help.

Sources of Information: Please provide all the documentation that you can for all generations which are not documented in The Groton Avery Clan. This can include copies of Census, Birth, Marriage & Death records, Bible records, Wills, Probate records, Diaries, Letters and Pictures... anything that will establish your line.

(Yourself)
I WAS BORN AT: _ ON
MARRIED TO: _ ON
PLACE OF MARRIAGE:
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
OUR CHILDREN: ________

MY [] FATHER OR [] MOTHER ON AVERY SIDE:
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Third Generation
MY [] GRANDFATHER OR [] GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Fourth Generation
MY [] GREAT-GRANDFATHER OR [] GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Fifth Generation
MY [] 2nd GREAT-GRANDFATHER OR [] 2nd GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Sixth Generation
MY [] 3rd GREAT-GRANDFATHER OR [] 3rd GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Seventh Generation
MY [] 4th GREAT-GRANDFATHER OR [] 4th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Eighth Generation
MY [] 5th GREAT-GRANDFATHER OR [] 5th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Ninth Generation
MY [] 6th GREAT-GRANDFATHER OR [] 6th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Tenth Generation
MY [] 7th GREAT-GRANDFATHER OR [] 7th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Eleventh Generation
MY [] 8th GREAT-GRANDFATHER OR [] 8th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Twelfth Generation
MY [] 9th GREAT-GRANDFATHER OR [] 9th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Thirteenth Generation
MY [] 10th GREAT-GRANDFATHER OR [] 10th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Fourteenth Generation
MY [] 11th GREAT-GRANDFATHER OR [] 11th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE: ______
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN:

Fifteenth Generation
MY [] 12th GREAT-GRANDFATHER OR [] 12th GREAT-GRANDMOTHER ON AVERY SIDE: _
PLACE OF BIRTH:_ ON_
PLACE OF DEATH:__ON
MARRIED TO: _ ON
PLACE OF MARRIAGE:
SPOUSE BORN AT: ON
SPOUSE DIED AT: ON
THEIR CHILDREN: ______

Please write additional generations beyond 15th on a separate piece of paper and enclose with application.

I certify that the above information is correct to the best of my knowledge and belief.
Signed:_
Date of Signing:_______

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