Please print this form and, after
completing it, send it with your search fee and a stamped
self addressed envelope to:
Please help us help you by PRINTING neatly.
When you forward your request to us
we would be grateful if you would also include as much supporting information
as you can. This will prevent us from simply sending you information
which you already have.
Your Full Name________________________________________Date______________
Brief Summary of Request - Please
attach any additional documents that may assist us:
Your Signature_________________________ Date __/__/_____
If you are happy for us to pass you name on to other researchers who are interested in the same family or research topic, please indicate. Share Information? Yes / No (Please circle one)
A minium of 2 hours is spent on is spent on each inquiry; hence $30 fee plus photocopying costs.
In very involved or follow up inquiries a further fee may be requested.
Date Received: __/__/_____
Amount Received: $_____.__ SAE? Y / N
Information Dispatched: __/__/_____
Research Coordinator: ________________________________