Morse Society Application - Life Membership
TIP: Complete this form on screen before printing it.

Name:

Address:

City:

State: Zip+4: + Province: Postcode:

Phone: Email:

Email me when each newsletter is available on the website and don't mail me the paper copy.
I am interested in volunteering with the Morse Society.  My specific areas of interest:
My oldest known Morse ancestor(s) in America:
 Anthony Morse
(d. 1686, MA)		  Samuel Morse
(d. 1654, MA)		  John Moss
(d. 1707, CT)
 William Morse
(d, 1683, MA)		  Joseph Morse
(d. 1646, MA)		  Unknown
 Other: 

Please enroll me in the Morse Society as a LIFE MEMBER.
I have selected my Life Membership fee based on my age:

My Current Age Life Membership Fee (USD)
under 40 $500
40-49 $400
50-59 $300
60-69 $200
over 69$100

REQUIRED I enclose a photocopy of a document verifying my age (e.g. drivers license).

I would like to make an additional donation of:

Total Payment:

I enclose my check in US funds payable to THE MORSE SOCIETY.
Charge my credit card: Expiration:
Acct. No.  Name (as printed on card): 

Signature _______________________________ Date __________

I have read the Morse Society's Privacy Policy.
(Must be checked to activate print button.)

Mail completed order form to:
The Morse Society
Kathie Halvey (Secretary), 3 Poplar Road, Beacon NY 12508-1552