Please print this form and mail it to the address below. We ask that you limit your requests to three names per week, as this will help the volunteers to fill the requests promptly. Providing variations of surnames and information on location helps the researchers track down the coat-of-arms.

Volunteers will search two standard sources: Herbarz Polski (Niesiecki) and Herbarz Polski (Slupincki). If these are not helpful, we will consult additional sources available in the library.

Please include a $5 donation per name if you are a PGSA member; the charge is $8 for non-members. If you are not already a member, please consider joining and taking advantage of membership benefits. Click here for the membership form. Donations are used for copies, equipment maintenance, general overhead, and supplies.

Surname	Surname variations	Location in Poland	Herb
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Are you a PGSA Member? Yes____ No______ Membership #_________

Email Address:_____________________________________

Name_______________________________________________________

Address _____________________________________________________

_________________________________________________________________

Please send your request with a Stamped Self Addressed Envelope to:

PGSA
984 N. Milwaukee Avenue
Chicago, IL 60622-4101