Tweed Heads Historical Society

Please fill this form with as much information as you can and then 

 Print This Page and post to PO Box 839 Tweed Heads 2485. 

Thankyou for your interest

TWEED DISTRICT PIONEERS REGISTER
A RECORD OF SOME OF THE RESIDENTS OF THE TWEED VALLEY OVER THE EARLY YEARS TO 1918

Pioneers Name		Given Names:
Born Date		Where:
Service Details
Fathers Name		Given Names
Mothers Family Name		Given Names:

PIONEERS LIFE DETAILS

Resided at
Occupation(s)
Died Date		Where
Buried Where

FIRST PARTNER

Surname:		Given Names:
Date Married:		Place:
Date Born:		Where:
Date Died:

SECOND/THIRD PARTNER

Surname:		Given Names:
Date Married:		Place:
Date Born:		Where:

CHILDREN

Given Names	Date Of Birth	Place Married	Married To	Date Of Death

BRIEF COMMENTS ON FAMILY HISTORY: (IF YOU NEED MORE SPACE PLEASE ADD AS MANY SHEETS AS YOU LIKE)

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Details provided by:
Address		Postcode:
Phone number:

I agree to the use of this information and any attached photos derivng from this Pioneer Form for research, publication in any format and/or broadcasting, exhibition, interpretation and for the use of bona fide researchers.

———————-                                                   —/—/2010
Signature                                                     Date