Registration Form
Name________________________________
(As you want it to appear on your name badge.)
Address______________________________
_____________________________________
E-mail or
telephone_____________________________
- Registration Fees:
- GRIVA member. . . . . . . . . . . . . . . $35 _______
- Non-member. . . . . . . . . . . . . . . . . $45_______
- 2007-2008 Dues. . . . .. . . . . . . . . . . . . . _______
(See note 3 below)
- Reservations made after 15 Sept. add $5 _____
- Total enclosed. . . . . . . . . . . . . .___________
Notes:
1. A box lunch and beverage is included in the registration fee.
2. Pre-registration is highly. Registrations will be received at the door, but
lunch cannot be guaranteed..
3. Not a GRIVA member? Include $15 for an individual membership or ($20 for family)
for your 2007-2008 membership.
4. Confirmation will be sent by e-mail. To receive confirmation by USPS mail
include a self-addressed, stamped postcard.
5. Questions? Call Dolly: (804) 639-4454 (evenings) or
e-mail.
Return this form and your check made payable to GRIVA to:
Dolly Pakurar
13912 Bayport Landing Road
Midlothian VA VA 23112
Fall Surname Exchange
We offer our members and friends the opportunity to make known their research
interests during the conference.
Please contribute three family lines you are
researching. A computer printout will be available at registration.
You’ll have all day to find your cousin!
(Example: Jones, late 18th cen., Augusta Co., Va.)
1. Name_________________________________
Date____________________________________
Location_________________________________
2. Name_________________________________
Date____________________________________
Location_________________________________
3. Name_________________________________
Date____________________________________
Location_________________________________