Please write plainly or print!
Do not request a history if the pioneer name does not appear in the History index.
| Your Name: | _______________________ |
| Address: | _______________________ |
| City, State, Zip | _______________________ |
| Phone | _______________________ |
| Email Address: | _______________________ |
| Pioneer Information | |||
|---|---|---|---|
| 1. Full name of Pioneer: | _________________________________ | ||
| (Women are filed by their married name, please list ALL married names of women.) | |||
| Birth Date: | ________________ | Death Date: | ________________ |
| 2. Full name of Pioneer: | _________________________________ | ||
| (Women are filed by their married name, please list ALL married names of women.) | |||
| Birth Date: | ________________ | Death Date: | ________________ |
| 3. Full name of Pioneer: | _________________________________ | ||
| (Women are filed by their married name, please list ALL married names of women.) | |||
| Birth Date: | ________________ | Death Date: | ________________ |
Are you a DUP paid up member? (Circle One) Yes No Membership Number: ______________
Are you a direct descendent of the pioneer you are requesting? (Circle One) Yes No
Histories will not be mailed without this completed form. You must be a DUP paid up member or a direct descendent of the pioneer requested to receive histories. If you are a direct descendent you must send a copy of your pedigree chart with this request form.
Please specify and mark or highlight ALL the names on your pedigree chart you would like copied and sent to you.
Some pioneer histories contain no more information than an obituary, etc. Many histories contain multiple different histories. Please tell us how much you want us to send to you. Total cost you want to spend: $_____________________ or Send it all ___________________
Copies are $0.25 per page, with a $1.00 minimum charge. Histories will be selectively copied and mailed to you with an invoice. Payment is due upon your receipt of the histories.
Print this form and mail to:
International Society of Daughters of Utah Pioneers
c/o History Department
300 North Main
Salt Lake City, Utah 84103
No email, phone, or fax requests will be processed. Please allow 3-4 weeks for processing of your request.