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Genealogy Form

Relatives: Would you like to be included in the family tree? You can use this form to send me your information via e-mail! Please fill out each applicable field. You can fill out a form for each member of your family if you wish. If there is any information you don't want posted publicly on the Web, just let me know in the section towards the bottom of the page.

1 Full name

2 Your e-mail address

3 Your mailing address

4 Maiden name

5 Confirmation name

6 Parents' names (Include middle and maiden names)

7 Siblings' names

8 Spouse's name (Include middle and maiden name)

9 Children's names (Include middle names)

10 Date of birth

11 Place of birth

12 Date of marriage

13 Place of marriage

14 Date of divorce

15 Date of death

16 Place of death

17 Place of burial

18 Cause of death

19 Religion (including any dates of conversion)

20 Education (dates and degrees received)

21 Occupation(s)

22 Retired? Yes Date No

23 Military service (dates, branch, rank)

24 Date of immigration to US

25 From what country?

26 Serious health problems

Please indicate any information you do not want published on the Internet

Any comments?

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