Authorizing form to publish data

I_______________________________daughter/son of ____________________________ and grand daughter/grand son of ________________________ authorize that the genealogical data that I am submitting be added to the Cyrenne and Syrenne family tree on the Web. (The names of your father and grand-father are needed to make connection between your data and that of the local computer).

I am submitting the following data: (i)

Personel genealogical data

Family name:_______________________________________
First name:______________________________________________
Born on: _____________________________________________
Born at:_______________________________________________
Married on: ___________________________________________
Married at:___________________________________________
Deceased on: _________________________________________
Deceased at: __________________________________________

Spouse's data (signature required)

Family name:_______________________________________
First name:_____________________________________________
Born on: _____________________________________________
Born at: ______________________________________________
Deceased on: _________________________________________
Deceased at: __________________________________________

Form for a deceased relative

If the form is for deceased relatives, do not forget to enter their deceased dates. Follow the date format (ii) for all dates entered. Enter your family relationship with the above relative (dauther, son, uncle, father etc...) ___________________

Please do not forget your signature,

your E-mail address: ___________________________and

your postal address on the back of the form

Signed at _______________ on ____/___/______ Your signature _________________Spouse / Witness_______________________

Mail to:
Genealogical Centre for Cyrenne/Syrenne
37 Buckingham rd
Val des Monts (Perkins) Qc
J8N 7L3

(i) Except for first and family names, all other fields are optionnelles
(ii) Date format: DD/MM/YYYY or /MM/YYYY or /YYYY

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