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<title>Ulster Ancestry Genealogy Questionnaire : Ancestral Research Service and Family Research</title>
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<h1>Research Questionnaire</h1>
<hr size="1" color="#008080"><table border="0" width="100%"><tr><td width="100%"><form action="process.php" method="POST">
<p><strong>Please fill in as much information as you can. Please list any sources already checked by you.</strong></p><div align="center"><center><table border="0" cellspacing="1" width="100%"><tr><td><font color="#800000"><strong>Your Name : *</strong></font></td><td><input type="text" size="30" name="Name" class="sm"></td></tr><tr><td><font color="#800000"><strong>Address :  *</strong></font></td><td><textarea name="Address" rows="4" cols="30" class="smtxt"></textarea></td></tr><tr><td><font color="#800000"><strong>Telephone : </strong></font></td><td><input type="text" size="30" name="Phone" class="sm"></td></tr><tr><td><font color="#800000"><strong>E. Mail :  *</strong></font></td><td><input type="text" size="30" name="Email" class="sm"></td></tr>
<tr><td><font color="#800000"><strong>E. Mail Confirmation : * </strong></font></td><td><input type="text" size="30" name="Email2" class="sm"></td></tr>
<tr><td>&nbsp;</td><td>&nbsp;</td></tr><tr><td><font color="#004000"><em><strong>Ancestors Details</strong></em></font></td><td>&nbsp;</td></tr><tr><td><font color="#800000"><strong>Ancestors
Name :</strong></font></td><td><input type="text" size="30" name="Ancestor_Name" class="sm"></td></tr><tr><td><font color="#800000"><strong>Religion : </strong></font></td><td><input type="text" size="30" name="Ancestor_Religion" class="sm"></td></tr>
<tr><td><font color="#800000"><strong>Place Of Birth : </strong></font></td><td><input type="text" size="30" name="Ancestor_Birth_Place" class="sm"></td></tr><tr><td><font color="#800000"><strong>Date Of Birth : </strong></font></td><td><input type="text" size="30" name="Ancestor_Birthday" class="sm"></td></tr><tr><td><font color="#800000"><strong>Fathers Name : </strong></font></td><td><input type="text" size="30" name="Ancestor_FName" class="sm" class="sm"></td></tr><tr><td><font color="#800000"><strong>Mothers Name : </strong></font></td><td><input type="text" size="30" name="Ancestor_MName" class="sm"></td></tr><tr><td><font color="#800000"><strong>Place Of Parents Marriage : </strong></font></td><td><input type="text" size="30" name="Ancestor_Parent_Marry_Place" class="sm"></td></tr>
<tr><td><font color="#800000"><strong>Date Of Parents Marriage : </strong></font></td><td><input type="text" size="30" name="Ancestor_Parent_Marry_Date" class="sm"></td></tr><tr><td><font color="#800000"><strong>Siblings Data : </strong></font></td><td><table border="0" cellpadding="3" cellspacing="3" width="100%"><tr><td align="center"><font color="#000080" size="2"><em><strong>Name Of Siblings</strong></em></font></td><td align="center"><font color="#000080" size="2"><em><strong>Date Of Birth</strong></em></font></td><td align="center"><font color="#000080" size="2"><em><strong>Place Of Birth</strong></em></font></td></tr> <tr> <td align="center"><input type="text" size="20" name="Ancestor_Sibling_Name"
class="sm">-&gt;</td> <td align="center"><input type="text" size="10" name="Ancestor_Sibling_DOB1" class="sm">-&gt;</td><td align="center"><input type="text" size="20" name="Ancestor_Sibling_Birthplace1" class="sm"></td></tr>
<tr><td align="center"><input type="text" size="20" name="Ancestor_Sibling_Name2" class="sm">-&gt;</td><td align="center"><input type="text" size="10"
name="Ancestor_Sibling_DOB2" class="sm">-&gt;</td><td align="center"><input type="text" size="20" name="Ancestor_Sibling_Birthplace2" class="sm"></td></tr> <tr><td align="center"><input type="text" size="20" name="Ancestor_Sibling_Name3" class="sm">-&gt;</td><td align="center"><input type="text" size="10" name="Ancestor_Sibling_DOB3" class="sm">-&gt;</td><td align="center"><input type="text" size="20"
name="Ancestor_Sibling_Birthplace3" class="sm"></td></tr></table></td></tr><tr><td><font color="#800000"><strong>Ancestors
Spouse :</strong></font></td><td><input type="text" size="30" name="Ancestor_Spouse" class="sm"></td></tr><tr><td><font color="#800000"><strong>Place of Ancestors Marriage :<br>( if in Ireland )</strong></font></td> <td><input type="text" size="30"
name="Ancestor_Marry_Place" class="sm"></td></tr><tr><td><font color="#800000"><strong>Date of Ancestors Marriage:</strong></font></td>
<td><input type="text" size="30" name="Ancestor_Marry_Date" class="sm"></td></tr><tr><td><font color="#800000"><strong>Children Data : </strong></font></td><td><table border="0" cellpadding="3" cellspacing="3" width="100%"><tr><td align="center"><font color="#000080" size="2"><em><strong>Names Of Children</strong></em></font></td><td align="center"><font color="#000080" size="2"><em><strong>Dates Of Birth</strong></em></font></td>
<td align="center"><font color="#000080" size="2"><em><strong>Places Of Birth ( if in Ireland ) </strong></em></font></td>
</tr><tr><td align="center"><input type="text" size="20" name="Ancestor_C_Name1" class="sm">-&gt;</td><td align="center"><input type="text" size="10" name="Ancestor_C_DOB1"
class="sm">-&gt;</td><td align="center"><input type="text" size="20" name="Ancestor_C_Birthplace1" class="sm"></td></tr>
<tr><td align="center"><input type="text" size="20" name="Ancestor_C_Name2" class="sm">-&gt;</td><td align="center"><input type="text" size="10" name="Ancestor_C_DOB2"
class="sm">-&gt;</td><td align="center"><input type="text" size="20" name="Ancestor_C_Birthplace2" class="sm"></td></tr><tr><td align="center"><input type="text"
size="20" name="Ancestor_C_Name3" class="sm">-&gt;</td><td align="center"><input type="text" size="10" name="Ancestor_C_DOB3" class="sm">-&gt;</td><td align="center"><input type="text"
size="20" name="Ancestor_C_Birthplace3" class="sm"></td> </tr><tr><td align="center"><input type="text" size="20" name="Ancestor_C_Name4"
class="sm">-&gt;</td>
<td align="center"><input type="text"
size="10" name="Ancestor_C_DOB4"
class="sm">-&gt;</td>
<td align="center"><input type="text"
size="20"
name="Ancestor_C_Birthplace4"
class="sm"></td>
</tr>
<tr>
<td align="center"><input type="text"
size="20" name="Ancestor_C_Name5"
class="sm">-&gt;</td>
<td align="center"><input type="text"
size="10" name="Ancestor_C_DOB5"
class="sm">-&gt;</td>
<td align="center"><input type="text"
size="20"
name="Ancestor_C_Birthplace5"
class="sm"></td>
</tr>
</table>
</td>
</tr>
<tr>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td><font color="#004000"><em><strong>Emigration
Details</strong></em></font></td>
<td>&nbsp;</td>
</tr>
<tr>
<td><font color="#800000"><strong>Date of
Departure : </strong></font></td>
<td><input type="text" size="30"
name="Emigration_Date" class="sm"></td>
</tr>
<tr>
<td><font color="#800000"><strong>Name of
Ship : </strong></font></td>
<td><input type="text" size="30"
name="Emigration_Ship" class="sm"></td>
</tr>
<tr>
<td><font color="#800000"><strong>Port of
Departure: </strong></font></td>
<td><input type="text" size="30"
name="Emigration_Port_Dep" class="sm"></td>
</tr><tr><td><font color="#800000"><strong>Port of
Arrival : </strong></font></td><td><input type="text" size="30"
name="Emigration_Port_Arr" class="sm"></td></tr>
<tr><td>&nbsp;</td><td>&nbsp;</td></tr><tr><td><font color="#800000"><strong>Additional Information :</strong></font></td><td><p align="left"><textarea name="More_Info" rows="6" cols="55" class="smtxt"></textarea></p></td></tr>
<tr>
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name="HowFindUA" rows="3" cols="55"
class="smtxt"></textarea></p>
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value="Submit Research Details" class="smbtn"></td>
<td align="center"><input type="submit" name="B2"
value="Reset the Form Details" class="smbtn"></td>
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<option value="ZAR">ZAR South Africa Rand</option>
<option value="KRW">KRW South Korea Won</option>
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<option value="SDD">SDD Sudan Dinars</option>
<option value="SEK">SEK Sweden Kronor</option>
<option value="CHF">CHF Switzerland Francs</option>
<option value="TWD">TWD Taiwan New Dollars</option>
<option value="THB">THB Thailand Baht</option>
<option value="TTD">TTD Trinidad and Tobago Dollars</option>
<option value="TRL">TRL Turkey Liras</option>
<option value="GBP">GBP United Kingdom Pounds</option>
<option value="USD">USD United States Dollars</option>
<option value="VEB">VEB Venezuela Bolivares</option>
<option value="ZMK">ZMK Zambia Kwacha</option>
<option value="EUR">EUR Euro</option>
<option value="XCD">XCD Eastern Caribbean Dollars</option>
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<option selected
value="USD">USD United States Dollars</option>
<option value="CAD">CAD Canada Dollars</option>
<option value="EUR">EUR Euro</option>
<option value="GBP">GBP United Kingdom Pounds</option>
<option value="JPY">JPY Japan Yen</option>
<option value="CHF">CHF Switzerland Francs</option>
<option value="DZD">DZD Algeria Dinars</option>
<option value="ARS">ARS Argentina Pesos</option>
<option value="AUD">AUD Australia Dollars</option>
<option value="BSD">BSD Bahamas Dollars</option>
<option value="BBD">BBD Barbados Dollars</option>
<option value="BMD">BMD Bermuda Dollars</option>
<option value="BRL">BRL Brazil Real</option>
<option value="BGL">BGL Bulgaria Leva</option>
<option value="CAD">CAD Canada Dollars</option>
<option value="CLP">CLP Chile Pesos</option>
<option value="CNY">CNY China Yuan Renminbi</option>
<option value="CYP">CYP Cyprus Pounds</option>
<option value="CZK">CZK Czech Republic Koruny</option>
<option value="XCD">XCD Eastern Caribbean Dollars</option>
<option value="EGP">EGP Egypt Pounds</option>
<option value="EUR">EUR Euro</option>
<option value="FJD">FJD Fiji Dollars</option>
<option value="FIM">FIM Finland Markkaa</option>
<option value="DEM">DEM Germany Deutsche Marks</option>
<option value="XAU">XAU Gold Ounces</option>
<option value="GRD">GRD Greece Drachmae</option>
<option value="HKD">HKD Hong Kong Dollars</option>
<option value="HUF">HUF Hungary Forints</option>
<option value="ISK">ISK Iceland Kronur</option>
<option value="INR">INR India Rupees</option>
<option value="IDR">IDR Indonesia Rupiahs</option>
<option value="ILS">ILS Israel New Shekels</option>
<option value="JMD">JMD Jamaica Dollars</option>
<option value="JPY">JPY Japan Yen</option>
<option value="JOD">JOD Jordan Dinars</option>
<option value="KRW">KRW Korea (South) Won</option>
<option value="LBP">LBP Lebanon Pounds</option>
<option value="LUF">LUF Luxembourg Francs</option>
<option value="MYR">MYR Malaysia Ringgits</option>
<option value="MXN">MXN Mexico Pesos</option>
<option value="NZD">NZD New Zealand Dollars</option>
<option value="NOK">NOK Norway Kroner</option>
<option value="PKR">PKR Pakistan Rupees</option>
<option value="XPD">XPD Palladium Ounces</option>
<option value="PHP">PHP Philippines Pesos</option>
<option value="XPT">XPT Platinum Ounces</option>
<option value="PLN">PLN Poland Zlotych</option>
<option value="ROL">ROL Romania Lei</option>
<option value="RUR">RUR Russia Rubles</option>
<option value="SAR">SAR Saudi Arabia Riyals</option>
<option value="SGD">SGD Singapore Dollars</option>
<option value="SKK">SKK Slovakia Koruny</option>
<option value="ZAR">ZAR South Africa Rand</option>
<option value="KRW">KRW South Korea Won</option>
<option value="SDD">SDD Sudan Dinars</option>
<option value="TWD">TWD Taiwan New Dollars</option>
<option value="THB">THB Thailand Baht</option>
<option value="TTD">TTD Trinidad and Tobago Dollars</option>
<option value="TRL">TRL Turkey Liras</option>
<option value="GBP">GBP United Kingdom Pounds</option>
<option value="USD">USD United States Dollars</option>
<option value="VEB">VEB Venezuela Bolivares</option>
<option value="ZMK">ZMK Zambia Kwacha</option>
<option value="EUR">EUR Euro</option>
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