Nomination Request |
Name | ______________________________ |
Address | _________________________________________________________ |
Telephone | ___________________ |
Originally From | ___________________ |
Date / Place of Birth | _______________________ |
Emigrated | __________ |
Spouse | _______________________ |
Children | ____________________________________________________________ |
____________________________________________________________ | |
Father's Name | _______________________ |
Mother's Name | _______________________ |
Brothers & Sisters | ____________________________________________________________ |
____________________________________________________________ | |
Notes | __________________________________________________________________________________ |
__________________________________________________________________________________ | |
__________________________________________________________________________________ |
Print, fill out, and mail this form to : Raymond Dib, 64-51 Fitchett ST, Rego Park, NY, 11374, USA
Please include a check payable to Raymond Dib, at a USA bank.Full Family Entry |
$ 200 USD |
Single Person Entry |
$ 100 USD |
Pictures |
$ 25 USD each |
Copyright © 1998-2007. Raymond Maurice K. H. Dib - New York. No reproduction is allowed without the expressed approval of the publisher. |