MONTHLY MEETING MEMBERSHIP RECORD

Member's full name _________________________________

      (If married name is different, put name at birth in parentheses)

Birth date __________ Birth place ________

ADMITTED TO MEETING MEMBERSHIP

Date ________ By request ________ By request of parents ________

      By birth ________

      By transfer certificate from the ________ Monthly Meeting

PARENTS

Father's name ____________________

Mother's name ____________________

ADDRESSES

Year     Street          Town          State

________________________________________

________________________________________

________________________________________

________________________________________

REMOVAL

Date membership ended: ________ by death ________ by release ________

       by certificate of transfer ________

       to the ________ Monthly Meeting

Place of burial ________________________

REMARKS:

 

The New York Yearly Meeting of the Religious Society of Friends