Member & Family Information Form

Please complete this membership form to insure your family records are accurate and up to date. We will use this information to determine your kinship and membership level.

This information is for internal Foundation use only and will be kept secure and not shared. Thank you.

Step 1 of 6

Your Personal Information

Prefix

Name

First Middle Last

Suffix

Birth Place

Birth Date

Preferred Phone

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Desired email address

Alternative Email

Other emails you may use to communicate with us.

Preferred Email?

How would you like to be contacted?

Are you a Scudder?

Yes

Parents Details

Parent Prefix

Parent Name

First Middle Last

Parent Suffix

Parent Birthplace

Parent Birthday

Is your Parent Living

Yes

Parent Deceased Date

Parent Deceased Place

You may visit the Scudder Ancestor in America Genealogical Database to research your lineage and accuracy.

Any errors or omissions need to be sent to the database administrators as we do not have access to their data. You can update our records with your ancestors information if you wish using this form.

Last Generation Found in Database

Would you like to include your family Information?

Yes

Great Grand Parent Name

Great Grand Parent Prefix

Great Grand parent Name

First Middle Last

Great Grand Parent Suffix

Great Grand Parent Birthplace

Great Grand Parent Birthdate

Great Grand Parent Deceased Place(if Known)

Great Grand Parent Deceased Date

Grand Parents Name

Grand Parent Prefix

Grand Parent Name

First Middle Last

Grand Parent Suffix

Grand Parent Birthplace

Grand Parent Birthdate

Is your Grand Parent Living

Yes

Grand Parent Deceased Place(if Known)

Grand Parent Deceased Date

Member & Family Information Form

Please complete this membership form to insure your family records are accurate and up to date. We will use this information to determine your kinship and membership level.

This information is for internal Foundation use only and will be kept secure and not shared. Thank you.

Your Personal Information

Parents Details

Great Grand Parent Name

Grand Parents Name

Sibling 1

Sibling 2

Sibling 3

Sibling 4

Sibling 5

Spouse / Partner

Spouse/Partner Name:

Child 1

Child 2

Child 3

Child 4

Child 5

Contact

Stay up to date