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Your Family History
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| Personel details of the person filling in this form. |
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Given Name:
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Surname:
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Address1 :
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Address 2:
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City:
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State:
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Country:
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Postcode:
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Email Address:
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Your interest in, or your connection with, Mooroopna.
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| Please complete the following: |
| As the provider of this information, I accept responsibility for the accuracy of all details provided. |
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| I understand the Historical Society of Mooroopna will make every effort to preserve the information provided by me but also understand the difficulties associated with long-term preservation. I therefore absolve the Society of any commitment to preserve and protect the information provided by me. |
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| If at any time, changes or additions to your family history are deemed necessary you might consider the necessity of providing the name(s) of any person authorised to do so. Do you wish to nominate any authorised person(s). |
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| I give permission for the archivist of the Historical Society of Mooroopna to use the information provided in any way considered appropriate to the aims of the Society. |
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| The information provided by me is wholly or partly confidential and must not be released to any third party without written consent from me. |
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| I would like to have my name and address added to the database of the Historical Society of Mooroopna for the purpose of receiving mailings and future information. |
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| I would like to join the Historical Society of Mooroopna as an ordinary member. |
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| Details of Family Name. |
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Family Name:
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Other related family names (surnames):
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Arrival in Mooroopna.
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Year of arrival:
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State or Country of origin:
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Key connections of first arrivals with Mooroopna
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Occupation(s):
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Principle place of residence:
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Family structure of first arrivals
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Please include:
Names of first arrival(s). Marital status. Dates of birth and death of each. Known places of birth and death; burial details.
Names of children, marriages and known dates of births and deaths. Known places of birth and death; burial details.
Names of grandchildren and subsequent generations with all known details of marriages, births and deaths. Known places of birth and death; burial details. |
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Photos and other documents.
If you are able to lodge photographs or other documents relating to your family, please give an outline of the items provided. Make sure all items are carefully labelled.
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Histories prior to Arrival
If you are able to lodge histories of families prior to their arrival in Mooroopna, please describe the information lodged.
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| Your connection with first arrival(s):
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| Please describe your family’s involvement with Mooroopna. |
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1. Original settlers/residents
- occupations/professions
- family activities, stories, special experiences
- civic involvement (schools, churches, clubs, organisations, etc)
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2. Descendents
- occupations/professions
- family activities, stories, special experiences
- civic involvement (schools, churches, clubs, organisations, etc)
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Other than any mentioned above, please consider the following:
- Civic awards
- Degrees, diplomas, certificates
- National, international recognition
- Local recognition, media reports, etc
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