Research Request Form - MHS 

The charge for basic assisted research is $15.00 per hour plus expenses for photocopying, etc. A stamped addressed envelope would be appreciated. Please provide as much information as possible. Please check with Secretary to see if research can be undertaken at other times. Completed forms should be mailed with payment to... Mansfield Historical Society - P.O Box 309, Mansfield, Victoria, Australia, 3723

Your Name:

Address

Phone                                                        E-Mail

Name of Family being researched

Your signature                                            Date

Office Use Only

Date Received:

Research Number:

Amount Received:

Researchers:

Information Dispatched:

Research Co-ordinator:

Please send any additional or other relevant information!