P. O. Box 7245

Groton, CT 06340-7245


Please print all information clearly.

NAME: [ ] Mr. [ ] Mrs. [ ] Miss [ ] Ms._________________________________________

STREET ADDRESS: _______________________________________________________

CITY: __________________________ STATE: ________ ZIP CODE:_______________

TELEPHONE NUMBER: ___________________________________________________

E-MAIL ADDRESS: _______________________________________________________

Would you like your newsletter sent by E-Mail? [__] Yes [__] No

Choice of Dues:
[__] Annual Individual (adult descendant or spouse).........$25.
[__] Annual Family (same household).................................$35.
[__] Life Individual.......................a one-time payment of $500.

The membership year is July 1 to June 30. Dues are due on July 1st and are payable in U.S. Dollars only. Donations of money or materials to the Association are deductible, within legal limits, for Federal tax purposes, and are very much appreciated.

Membership Categories (check one):

[__] Friend of The Avery Memorial Association - Fill in the above information ONLY . Members in this category cannot establish a genealogical connection to James Avery (1621 - 1700), but will have the same rights and benefits as those of proven James Avery descendants.

[__] Active Member (Descendant of Christopher Avery) - Fill in the above information AND the rest of this application. My ancestry is from one of the children of James Avery (1621 - 1700), son of Christopher Avery, who setled in Groton, CT circa 1650, of which I can prove bloodline descent, as demonstrated in the attached genealogy.

Please make your check payable to "The Avery Memorial Association."
Send Application and dues to:
The Avery Memorial Association
P. O. Box 7245
Groton, CT 06340-7245


Please trace your lineage starting with yourself. Then enter in the next space the Avery descendant, Father or Mother as the case may be. The Groton Avery Clan (1912) geneaology may provide you with much of your complete line, and, if so, place the assigned genealogy number opposite the respective ancestor. Once your line is traced to an ancestor in the book, no further documentation will be needed. If you need further assistance, we may be able to help.

Sources of Information: Please provide all the documentation that you can for all generations which are not documented in The Groton Avery Clan. This can include copies of Census, Birth, Marriage & Death records, Bible records, Wills, Probate records, Diaries, Letters and Pictures... anything that will establish your line.


Submitted by __________________________________________________________________Date___________________________

Please submit any obits, newspaper articles or pictures of ancestors.

APPLICANT’S LAST NAME at BIRTH ________________________________________________________________________

FIRST and MIDDLE GIVEN NAMES at BIRTH_______________________________________________________________

DATE BORN _________________________________________ BAPTIZED_____________________________________________

PLACE BORN (TOWN, COUNTY, STATE)___________________________________________________________________

DATE DIED (or buried)(“L” if living)________________________________________________________________________

CEMETERY, Town, County, State) __________________________________________________________________________

ADDRESS for newsletter_____________________________________________________________________________________

E-MAIL ADDRESS _____________________________________________________________________________________________

PHONE NUMBER with AREA CODE__________________________________________________________________________

FATHER’S FULL NAME AT BIRTH___________________________________________________________________________

MOTHER’S FULL NAME AT BIRTH___________________________________________________________________________

NAME OF SPOUSE AT BIRTH________________________________________________________________________________

DATE & PLACE OF SPOUSE'S BIRTH__________________________________________________________________________

DATE & PLACE OF MARRIAGE_______________________________________________________________________________

MARRIED STATUS (Married)__________________(Widowed)_______________________Divorced________________

NAME OF SPOUSE’S FATHER AT BIRTH_____________________________________________________________________

NAME OF SPOUSE’S MOTHER AT BIRTH____________________________________________________________________

DATE & PLACE OF MARRIAGE_______________________________________________________________________________

MARRIED STATUS (Married)__________________(Widowed)_______________________Divorced________________

NAME OF CHILDREN AT BIRTH _____________________________________________________________________________

DATE & PLACE OF BIRTH_____________________________________________________________________________________

Indicate date & place of birth for each spouse and children that go with that spouse. Repeat spouses & children on reverse side of page. You may submit family group sheets. You may submit family group sheet for the generations following your generation.

I AM THE CHILD OF ___________________________________________________________________________________________

WHO WAS BORN ON__________________________________________________________________________________________

IN WHAT TOWN, COUNTY & STATE_________________________________________________________________________

DIED ON WHAT DATE AND PLACE__________________________________________________________________________

CEMETERY, TOWN, COUNTY, STATE________________________________________________________________________

MARRIED DATE & PLACE_____________________________________________________________________________________


DATE & PLACE OF BIRTH OF SPOUSE_______________________________________________________________________

DATE & PLACE OF DEATH OF SPOUSE______________________________________________________________________

CEMETERY, TOWN, COUNTY, STATE________________________________________________________________________

FATHER OF SPOUSE___________________________________________________________________________________________

MOTHER OF SPOUSE__________________________________________________________________________________________

Please write additional generations on a separate piece of paper
and enclose with application.

I certify that the above information is correct to the best of my knowledge and belief.


Date of Signing:_____________________

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