Pilgrim Edward Doty Society Membership Application Form

Please fill in the blanks, print this page, enclose in an envelope with a check made payable to "The Pilgrim Edward Doty Society", and mail to:
The Pilgrim Edward Doty Society
c/o Judy Wilson
PO Box 247
Manzanitz, OR 97130

First Name     Last Name

Street Address

City     State or Province

Zip or Postal Code     Country, if not U.S.

Home Telephone      E-mail

Select one of the following options:

Regular Membership $15/year
Junior Membership $15 one-time fee. Birth Date, Required (M, D, Y)   

How did you hear about the Pilgrim Edward Doty Society?

  Internet Search Engine
  From a friend or family member
  Through a genealogical organization
  Other 

If you believe that you are related to Edward Doty, from which of his children are you descendant?

Edward    John    Thomas    Samuel    Desire      Isaac   Joseph     Mary

If you wish to include Lineage Information with your application, you must use this form and send it along
with your application form to the address above.

If you are a woman, was your maiden name Doty?

Yes       No

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If you would like a membership brochure sent to a friend or relative, please provide their name and address: