First Name*Last Name*Email* Phone*Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code What is your preferred method of contact?*EmailPhoneMailResearch TopicPlease describe your research topic or area of interest:*(Example: family genealogy, local business history, notable historical event, etc.)Specific location or site (if applicable):Timeframe or dates of interest (if applicable):Relevant names (individuals, families, businesses, etc.):Research QuestionsQuestion 1Question 2Question 3Available InformationDo you have any of the following documents or details that might assist us in your research?(You may be asked to send files before your visit. If not, please plan to bring them during your scheduled appointment.) Photographs Letters or diaries Newspaper clippings Official records (birth, marriage, death, etc.) Other Select AllIf you have selected "Other" above, please specify here:*Purpose of ResearchWhat is the purpose of your research?* Personal (genealogy or family history) Academic (thesis, dissertation, article, etc.) Public / Community Project (exhibit, publication, event, etc.) Other If you have selected "Other" above, please specify here:*Deadline or TimeframeDo you have a specific deadline for receiving information?* Yes No If yes, what is your deadline?*AgreementBy submitting this form, you agree to the terms and policies of the Historical Society of Quincy and Adams County, including any fees or usage restrictions that may apply to research services. HSQAC members are exempt from research fees. Research fees for non-members are $15/hour, plus an additional fee for photocopies.Please type your name as your agreement to these terms and policies:*Today's Date:* Month Day Year CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
