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