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ELGIN GENEALOGICAL SOCIETY

Web Page Surname Information

Members may print this form to add or change surname information

Member Name  ___________________________________

E-mail Address  ___________________________________

US Mail  ________________________________________

Surname Information:

Name

Location

Dates (from-to)

     
     
     
     
     
     
     
     
     

I authorize the Elgin Genealogical Society to publish the above on the EGS website

Signature ____________________________________  Date ____________________

If this is an update of the current information the E-mail and US Mail addresses may be
omitted unless they have changed.

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