Applicant registration form


treeThe information collected on this form is used to create the Family Tree and Family Directory. Please complete as much information as possible for you and your immediate family (mother, father, children, siblings, grandparents). Email completed form to admin@collins-kin.com, or mail to Deborah A. Collins-Nears at 3699 Micah Court, Ellenwood, GA 30294. Attach photographs, birth certificates or death certificates at your option.

APPLICANT

  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Gender
  • Mailing Address
  • City/Town
  • State
  • Country
  • Postal Code
  • Home Phone
  • Cell Phone
  • Email
  • Facebook Address
  • Please add my contact information to the Family Directory *

    YesNoOther: No Comment

  • Date of Birth
  • Place of Birth (City, State, Country)
  • Occupation
  • Hobbies

1. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

2. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

3. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

4. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

5. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

6. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

7. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

8. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

9. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

10. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

11. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

12. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

13. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

14. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s

15. IMMEDIATE FAMILY MEMBER

  • Relationship
  • First Name
  • Middle Name
  • Maiden Name
  • Last Name
  • Life Event
  • Date
  • Place of Event (City, County, State, Country)
  • Birth
  • Marriage
  • Death
  • Occupation & Hobbies
  • Sibling’s Mother or Father’snameif different from Applicant’s