Information Survey

The purpose of this survey is to collect information from you as a member of the family which will enable us to update our records to the stage whereby we can add more information to our Family History Book.

This survey is divided into the following sections

	Section A Husband.
	Section B Wife
	Section C Children.
	Form Submission

Please fill out the information in each section as requested. Then at the end of the form supply your name and contact information, and submit the form. You will receive a confirmation message from us shortly.

SECTION A -- Husband:

Full Name
Born: Place:
Chris: Place:
Marriage: Place:
Died: Place:
Buried: Place:
Father: Mother:
Other Wives:

SECTION B -- Wife:

Full Name
Born: Place:
Chris: Place:
Marriage: Place:
Died: Place:
Buried: Place:
Father: Mother:
Other Husbands:

SECTION C -- Children:

```
Name:Sex:Born:Place:
```

	                           Died:Place:

     Married to: Date:Place:

  2. Name:Sex:Born:Place:

	                           Died:Place:

     Married to: Date:Place:

  3. Name:Sex:Born:Place:

	                           Died:Place:

     Married to: Date:Place:

  4. Name:Sex:Born:Place:

	                           Died:Place:

     Married to: Date:Place:

  5. Name:Sex:Born:Place:

	                           Died:Place:

     Married to: Date:Place:

  6. Name:Sex:Born:Place:

	                           Died:Place:

     Married to: Date:Place:

For the convenience of correspondence and notification of events could you please complete the following section.

Name     
Street   
City      
State     Phone:
Zip Code  Email:

Please enter any additional comments regarding our Group:

Contact Information

Webmaster:
Ken Witchard
108 East St
Bega NSW 2550 Australia
Telephone: +61 2 64923 060
Mobile: +61 428 500407
E-mail: witchweb@iinet.net.au

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Last modified: August 18, 2020