NAME:_______________________________________________________________

ADDRESS:___________________________________________________________

ADDRESS:____________________________________________________________

CITY:________________________________________________________________

STATE:____________________   COUNTRY:____________________

ZIP/POSTAL CODE:______________

OPTIONAL INFORMATION:

E-MAIL:________________________________________________________________

WEB PAGE:______________________________________________________________

MAIDEN NAME:___________________________________________________________

NAMES RESEARCHING:_____________________________________________________

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(CONTINUED)____________________________________________________________

(CONTINUED)____________________________________________________________

The last few lines are optional. However, from time to time, we send out announcements by e-mail, so we hope you will share this information with us. We are working towards a database of names being researched, so people researching the same names will be able to contact one another.

Please mail your application and $10.00 per individual, or $15.00 per couple to:

Sumner County Historical and Genealogical Society, Box 402, Wellington, Kansas, 67152