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Please fill out and submit this form if you would like to add a surname, add additional
information to one of the already listed surnames or to identify a person who would be
willing to act as a resource contact.

Please enter the surname you wish to register.

Please enter the first name(s) of the original settlers.

What were the approximate years they lived in Gallia County?

In which township(s) did they live?

With what other surnames did they intermarry?

Do you wish to be listed as a resource for this surname whom researchers could contact for information? yes no

If yes, please list your name and e-mail address.

Type additional comments here: (100 words or less):

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