RESEARCH FORM

Note: no research will commence until payment of $25.00 per surname has been received

Print & mail this form with a cheque for $25.00 per surname or 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 Westpac Bank BSB 033 624 Account Number 41 24 77 and advise that your payment has been made and the reference you have used.


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. No research will commence until payment of $25.00 per surname has been received.

 

I
  would like The Gisborne & Mount Macedon Districts Historical Society to research on my behalf.

RESEARCHERíS 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