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
Tax Deductible Contribution _______________ 628 E Grand Ave
Credit Card _______________ Des Moines, IA 50309-1924
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: ___________________
