Name Tag Form

Your information as it will appear on the name tag. Please PRINT clearly.

Your name: _______________________________________________________

Father's name: _____________________________________________________

Father’s Father’s name: ______________________________________________

Father’s Mother’s name: _____________________________________________

Mother’s name: ____________________________________________________

Mother’s Father’s name: _____________________________________________

Mother’s Mother’s name: ____________________________________________

You may pay by check or credit card. If paying by credit card also fill in the credit card 
information and add an additional fee of $2.50. Cost: $10.00, due at time of order. Name 
tags may be picked up at the IGS Library. Allow 4 weeks for delivery. If a bulk order, contact 
the IGS office at 515 276-0287 for arrangements
 
Name Tag – $10.00 _______________ Please remit in US funds to:
Shipping – $3.00 _______________ Iowa Genealogical Society 628 E Grand Ave
Tax Deductible Contribution _______________ Des Moines IA 50309-1924
Credit Card _______________
Amount Enclosed ______________
 
Please Print or type:
 
Name:____________________________________________
 
Street:____________________________________________
 
City, State, Zip Code: ________________________________
 
Email, Phone: ______________________________________
 
A $2.50 Processing Fee will be added to all credit card purchases
 
Signature:_________________________________________
 
For Credit Card Purchases:     Visa     Mastercard     Discover
 
Credit Card Number: ________________________________
 
Exp. Date: ________________ CVV: ___________________