Family History Form
Please fill out this form if you want to submit your family information.
Name(s)_______________________________maiden
_____________________________married
_________________spouse/significant other
__________________children ____age
__________________children ____age
__________________children ____age
__________________children ____age
__________________children ____age
__________________ children ____age
Current Addresses
Street______________City____________St____Zip______
Phone____________________CellPhone_______________
Career Info: If you care to share what you do for a living please write it in here
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Education:_______________________________________________________________________________
_______________________________________________________________________________________
Family Activities________________________________________________________________________________
_______________________________________________________________________________________
Children, Grand Children and Family Highlights:____________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Email Address_________________________________________________________________________________
Survey Question:
If the family was able to organize a family reunion would you attend? ___yes ___no
Would you be interested in serving on a committee should we have a reunion? ___yes ___no
If yes what area would you most likely be interested in? ____mailing_____site prepartion____games_____food preparation____fundraising___finance___promotion____history____decorations_____.
We appreciate your participation in this Email and Family History Worksheet. Please print and send to: News at Copp Family Newsletter, c/o Karen Phillips,
I ______________________________agree to have my information above listed on the CoppFamilyNY website and database with the intent of sharing said informaiton to our relatives. This information will be made publc and I am aware of this by signing.
I___________________________do not agree to have my information listed on the website but am sending it to the editor, Karen Phillips for the sole purpose of keeping touch via mail or email for updates on our family history and reunion information.
