RESEARCH FORM

Note: no research will commence until payment of $35.00 per surname has been received

Print & mail this form with a cheque for $35.00 per Surname or topic to or $55.00 for Business

Per topic to: Gisborne & Mount Macedon Districts Historical Society Inc. 4 Hamilton Street Gisborne Victoria 3437

Or copy and paste the form to a word document & email to:   history@gisbornemountmacedon.org.au

And pay by direct deposit to Bendigo Bank BSB 633000 Account Number 139872584 and advise that your payment has been made and the reference you have used.

Photographs if available cost $ 7.50 per image on a USB Stick provided by you.


GISBORNE & MT. MACEDON DISTRICTS HISTORICAL SOCIETY INC.
ABN 82 893 878 458 Inc. No. A 0027147L request the Gisborne & Mount Macedon Districts Historical Society to research on my behalf.
I  hereby request The Gisborne & Mount Macedon Districts Historical Society to research on my behalf.

RESEARCHER’S NAME:
ADDRESS:
PHONE: POSTCODE:
*E-MAIL: *WEBSITE:
SURNAMES OR TOPICS TO BE RESEARCHED:
1 2
   
3 4
 
   
YOUR RELATIONSHIP OR INTEREST:
 
 
SIGNATURE OF RESEARCHER:

 

 DATE:

 

 * When applicable