VASA ORDER OF AMERICA NATIONAL ARCHIVES INC.
A Swedish American Fraternal Organization
GENEALOGY INFORMATION

Please TYPE or PRINT                                                      Date Submitted 
email                        phone 
NAME        OCCUPATION  
ADDRESS       ZIP 
Birthplace   
                                                                              City                                                      State/Lan                                          Country
Date Of Birth: M D    Y         Date Of Entry In U.S. Or Canada    
Vasa Lodge Affiliation (If Any)      No      Initiation Date 
Name of  Spouse              Marriage Date   
Date Of Birth: D    Y         Spouse. Please Submit A Separate Genealogy Form

Names Of Children                                                                                      Date And Place Of Birth
Father                     Birth date 
Birthplace   Date And Place Of Death 
Mother                    Birth date 
Birthplace   Date And Place Of Death 
Paternal Grandfather      Birth date 
Birthplace   Date And Place Of Death 
Paternal Grandmother   Birth date 
Birthplace   Date And Place Of Death 
Maternal Grandfather     Birth date 
Birthplace   Date And Place Of Death 
Maternal Grandmother   Birth date 
Birthplace   Date And Place Of Death 

USE SEPARATE SHEETS TO DESCRIBE ADDITIONAL FAMILY HISTORY
Mail To: Vasa Order Of America National Archives, Box 101, BISHOP HILL IL 61419

 If you prefer, you may Print and Mail this form instead.
Fill in the boxes and mail to the Archive at the address above.