Application For Membership In The
Roger Williams Family Association

If you would like to become a member of our organization, please print and complete this form. If you prefer, you may cut & paste this form into your own word processing program and print from there.

Please refer to the How To Join page for submission information.

Sources are REQUIRED. Incomplete applications will be returned.

Date: _______________

I do hereby make application to become a member of the Roger Williams Family Association.

I enclose $10 for annual membership (per person) plus $25 application fee (or $35 for multiple annual memberships within family submitted together)


or $75 for life membership (no application fee required).

Applicant's Name (print) ______________________________

Applicant's Signature ______________________________

Street ___________________________________________

City _______________     State _____     Zip ______

Telephone (_____) _______________

E-Mail ____________________

DO NOT WRITE IN THE BOX BELOW - FOR REGISTRAR'S USE ONLY

The family record of the applicant as connected with Roger Williams having been duly examined, it  is reported upon ___favorably by: ______________________________, Registrar Elected to membership _______________ (date) ______________________________, Recording Secretary

STATEMENT OF LINE OF ELIGIBILITY FOR MEMBERSHIP

1. Roger Williams of Providence, Rhode Island __________ (specify son or daughter) was:

2. ____________________ who married __________ and had __________ (son/dtr):

3. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

4. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) __________________________________________________

5. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

6. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

7. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

8. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

9. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

10. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

11. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

12. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

13. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

14. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

15. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

16. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

17. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

18. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

19. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

20. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

21. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

22. ____________________, born at ____________________ on _______________,

died at ____________________ on _______________,

married at ____________________ on _______________ to:

____________________, born at ____________________ on _______________,

died at ____________________ on _______________. Their __________ (son/dtr) was:

SOURCE(S) _______________________________________________________

_______________________________________________________