| No. | ........Family Name....... | ....Place of Interest.... | County Code | Period of Interest |
| eg | Anyname | Bromyard | HEF | 1820-1840 |
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I understand that the above details will be stored on computer disc. The information is used only for administration purposes and in the pursuit of the objectives of the Society, namely to promote and encourage the study of family History. The Society is Registered under the Data Protection Act, for further details click here.