YOUR INFORMATION

Your Name (required)

Your JMA Number (if you don't know it, enter your parent's name(s))

Your E-mail Address (or phone or post address) (required)

NEWBORN/ADOPTED COUSIN DATA

Mark one: Male Female

Given Name(s) (John, Elizabeth, etc.)

Middle Name(s)

Surname (More, Smith, Johnson-Cramer, etc.)

Suffix (Jr., III, etc.)

Birth Order (1st child, 2nd child, etc.)

Birth Date (12 November 2004)

Place of Birth (City and State/Province)

Check if Adopted.

Full Name of JMA Cousin Parent

JMA Number of Parent (if unknown, leave blank)

Full Name of Other Parent

Mark if the Other Parent legally married to the JMA parent.

NOTES

Please enter any additional information, clarifying comments, or requests/questions here:

REPORTS

Mark which format you would like to receive your Family Report in.

Please E-MAIL me a copy of my updated family record in EXCEL FORMAT.
Please SEND me a copy of my updated family record in PRINT FORMAT by post.
I don't need any reports at this time.

Enter e-mail or post address here if you are requesting a report
and the information is not already listed above:

LINE NEWS

Unless otherwise indicated, the information above will be published in Line News of The Historical Journal.

Mark here only if you DO NOT want the information above included.

Please consider submitting a photo and/or article for The Historical Journal to accompany the information you have just provided. To submit:

* E-mail a JPEG format photo to Cindy Leigh, Journal Editor
* E-mail a Microsft Word document for any articles.


Include a self-addressed and stamped envelope if you'd like your photo returned. Cindy's mailing address is in the JMA Journal.