(Please Type or Print)

I hereby apply for membership in the WALTER PALMER SOCIETY, by right of my

descent from WALTER PALMER as documented herewith.

        I hereby apply for associate membership in the WALTER PALMER SOCIETY by right of my descent from WALTER PALMER as documented herewith.

Full Name__________________________________________________

Address____________________________________________________

State_____________ Zip_____________ Signature__________________________

Full Name of Spouse__________________________________________

Birthplace of Spouse_____________________________ Date______________________

Full Name - Father of Spouse___________________________________

Maiden Name - Mother of Spouse___________________________________

APPLICANT'S CHILDREN AND GRANDCHILDREN

NAME              RELATIONSHIP              BIRTHDATE        BIRTHPLACE

Approved by the Registrar____________________________________________

                                                                         (Registrar's Signature) (Date)

Approved by Directors _____________________________________________

                                                                          (Secretary's Signature) (Date)

STATEMENT OF LINE OF ELIGIBILITY FOR MEMBERSHIP

1) WALTER PALMER [ ] m.1________________________,their child was:

                                 [ ] m.2 Rebecca Short___________, their child was:

2)__________________________ m._____________________, their child was:

3)__________________________ m._____________________, their child was:

4)__________________________ m._____________________, their child was:

                                                                                          DATE       PLACE

5)_______________________________________________ b._________ ____________

                                                                                      d._________ ____________

m._____________________________________                   b._________ ____________

                                                                                       d._________ ____________

m.________ ____________

Their Child Was:

6)_______________________________________________ b._________ ____________

                                                                                      d._________ ____________

m._____________________________________                   b._________ ____________

                                                                                       d._________ ____________

m.________ ____________

Their Child Was:

7)_______________________________________________ b._________ ____________

                                                                                      d._________ ____________

m._____________________________________                   b._________ ____________

                                                                                       d._________ ____________

m.________ ____________

Their Child Was:

8)_______________________________________________ b._________ ____________

                                                                                      d._________ ____________

m._____________________________________                   b._________ ____________

                                                                                       d._________ ____________

m.________ ____________

Their Child Was:

9)_______________________________________________ b._________ ____________

                                                                                       d._________ ____________

m._____________________________________                    b._________ ____________

                                                                                        d._________ ____________

m.________ ____________

Their Child Was:

10)_______________________________________________ b._________ ____________

                                                                                        d._________ ____________

m._____________________________________                     b._________ ____________

                                                                                         d._________ ____________

m.________ ____________

Their Child Was:

11)_______________________________________________ b._________ ____________

                                                                                        d._________ ____________

m._____________________________________                     b._________ ____________

                                                                                         d._________ ____________

m.________ ____________

Their Child Was:

12)_______________________________________________ b._________ ____________

                                                                                        d._________ ____________

m._____________________________________                     b._________ ____________

                                                                                         d._________ ____________

m.________ ____________

Their Child Was:

13)_______________________________________________ b._________ ____________

                                                                                        d_________ ____________

m._____________________________________                     b._________ ____________

                                                                                         d._________ ____________

m.________ ____________

Their Child Was:

14)_______________________________________________ b._________ ____________

                                                                                        d._________ ____________

m._____________________________________                     b._________ ____________

                                                                                         d._________ ____________

m.________ ____________

Their Child Was:

15)_______________________________________________   b._________ ____________

                                                                                          d._________ ____________

m._____________________________________                       b._________ ____________

                                                                                           d._________ ____________

m.________ ____________

For each birth, death and marriage, cite tital, author, volume, and page or attach copies of Bible records, church, census, cemetery, court, or other such records as will verify eligibility for membership.

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

11)

12)

13)

14)

15)

16)

17)

For each generation, please include any available biographical information not included in either PALMER GROUPS, by Emily Wilder Leavitt 1901-5 of WALTER PALMER 1585-1985, by Doris Palmer Buys or elsewhere in this application for membership.

Information of applicant relating to education, occupation, memberships in patriotic, fraternal, genealogical, historical, military or civic nature, accomplishments of note, and religious affiliations should be lister hereunder.

Please mail completed application along with $25.00 for a regular membership or $100.00 for a life membership to: