MEMBERSHIP APPLICATION

THE AVERY MEMORIAL ASSOCIATION

MEMBERSHIP APPLICATION

NAME: [ ] Mr. [ ] Mrs. [ ] Miss [ ] Ms.____
STREET ADDRESS:
CITY: STATE: ZIP CODE:_
TELEPHONE NUMBER: _________________
E-MAIL ADDRESS: _
Choice of Dues: Annual = $25 per year OR Lifetime Dues = $500 (Dues increased on July 1, 2008)
Dues are payable in U.S. Dollars only. Donations of money or material to the Association are deductible, within legal limits, for Federal tax purposes. Please make your check payable to "The Avery Memorial Association."

Membership Categories (check one):
[] Friends of The Avery Memorial Association - Fill in the above information ONLY and send in application with your choice of dues to The Avery Memorial Association, P.O. Box 7245, Groton, CT 06340-7245.
[] Active Member (Descendant of Christopher Avery) - Fill in the above information AND the rest of this application and send application with your choice of dues to The Avery Memorial Association, P.O. Box 7245, Groton, CT 06340-7245.
I WAS BORN AT: ON
MARRIED TO: ON
SPOUSE BORN AT: ON
CHILDREN: ________________
FATHER OR MOTHER ON AVERY SIDE:
I certify that the above information is correct to the best of my knowledge and belief.
Signed:_
Date of Signing:_______

In the following Genealogy, please cite "The Groton Avery Clan" number of your early ancestors and/or note other sources:

Third Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Fourth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Fifth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Sixth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Seventh Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Eighth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Ninth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Tenth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Eleventh Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Twelfth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Thirteenth Generation
Son:
Date & Place born:
Daughter:
Date & Place born:
Who married:
Date & Place of Marriage:

Please write additional generations beyond 13th on a separate piece of paper and enclose with application.

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