Please print this form, fill in the details, and post to us with a preliminary search fee of €95
South Mayo Family Research,
Main St., Ballinrobe, Co. Mayo, Ireland
Date: ____________________________________
Applicant's Name: _____________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
In the following questionnaire please give as many details as possible. Please add any other information
which you think may be relevant.
Name of my ancestor: _________________________________________________________________
Date of Birth: _________________________________________________________________________
Place of Birth: ________________________________________________________________________
Father's Name: _______________________________________________________________________
Father's Date of Birth __________________________________________________________________
Mother's Name: ______________________________________________________________________
Mother's Date of Birth: _________________________________________________________________
Their Place of Birth: ___________________________________________________________________
Their religious denomination: ___________________________________________________________
Date/Place of their marriage: ___________________________________________________________
Siblings of Ancestor named above: _______________________________________________________
____________________________________________________________________________________
When did your ancestor emigrate?: _______________________________________________________
Other relevant information: ______________________________________________________________
Master Card or Visa. Please enter Credit Card details below.
Account No _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Card Holder's name ______________________________________________
Expiry Date ______________________
Type of Card _____________________________
Card Holder's address _______________________________________
________________________________________________________________
Signed by Card Holder _______________________________________________
As part of our on-going market research programme, we would be grateful if you completed the following: (This information is purely for statistical purposes.)
Q1) How did you hear about the Mayo Family History Centres?
_____________________________________________________________________
_____________________________________________________________________
Q2) Please indicate whether you are Male or Female ____________
Please indicate with your age group: 18-24, 25-34, 35-44, 45-54, 55-64, 65+ _________
Q3) Your occupation: ______________________________________________________________
Your co-operation is much appreciated.
Customer No.: ____________________ Date: ____________________
(c) Copyright Mayo Family History Marketing Company Ltd.