Name Tag Form

Print out this page and fill out the the form.  Follow the payment and mailing instructions listed below.
Your information as it will appear on the name tag. ImportantPlease 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:
City, State, Zip Code: ________________________________
Email, Phone: ______________________________________
A $2.50 Processing Fee will be added to all credit card purchases
For Credit Card Purchases:     Visa     Mastercard     Discover
Credit Card Number: ________________________________
Exp. Date: ________________ CVV: ___________________