GwentFHS UPDATE MEMBER'S INTERESTS Form

CYMDEITHAS HANES TEULUOEDD GWENT
Registered Charity No.702333 (registered in England & Wales)
UPDATE OF MEMBER'S INTERESTS

Title
Initials
Surname
Membership No.
E-mail Address
Postal Address
Date

Please REPLACE ALL details of my Member's Interests, currently
held on the Society's database, with the following:-
Please print details in BLOCK CAPITALS of UP TO TEN names you are researching, which you wish to be included on
our Members' Interests Database:- (if the surname is a common one, you may add forename(s), e.g. "JONES, ANN").

Surname	Parish, Town or Village	County/Country CODE*	Period

* For Country/County Codes, please use the standard Chapman Codes (see our website for details)

I wish the above details to be held by Gwent Family History Society on its Members' Interests Database. I understand that, if these are accepted, they will be stored on computer, and published, together with my contact details, initially in the Society Journal, also from time to time in the Members' Interests Directory, and may be passed, on request, to other researchers. Where the Society displays its Members' Interests on the Internet, I understand that mine can only be included if I give specific permission for this to be done.

I hereby therefore request that my interests as held by the society, and my postal & my email address shall be published on the Internet...

(You may delete either postal or email address from the above, but not both)

Whilst agreeing with their publication in the journal and directory, I hereby refuse to permit my interests and contact details to be published on the Internet.................................

Please sign one of these options, either A or B.

Please return this completed form to:
The Membership Secretary, Gwent FHS, 5, Brookside, Bettws, Newport, Gwent, NP20 7EG

This section is for use by the Society's Officers

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