WOODEND & DISTRICT HERITAGE SOCIETY INC.
Local & Family History Resource Centre
ABN 59 338 256 068
Research Request Form
Please print this form and, after
completing it, send it with your search fee and a large A4 stamped self
addressed envelope to:
The Woodend & District Heritage Society
PO BOX 124, WOODEND, 3442. Australia
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______________
Phone Number Business __________________
Phone Number Home __________________
Fax Number __________________
Brief Summary of Request - Please attach any additional documents that may
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)
Within Australia: Full search including a reasonable amount of photocopying - $25.00 . Includes postage and GST and is valid for a 12 month period.
Overseas: $A30. This includes a reasonable amount of photocopying and return postage by airmail.
For our direct bank deposit: BSB: 033 674 A/c No. 480742
Please identify the deposit with your name, and note as "search fee".
Date Received: __/__/__
Amount Received: $_____.__ SAE? Y / N
Information Dispatched: __/__/__
Research Coordinator: ________________________________