Application For Membership - Port Phillip Pioneers Group

Application For Membership of the Port Phillip Pioneers Group

If you would prefer to obtain, print and fill in the form instead of using the online form below, you can send a request for these forms by emailing our Examiner of Proofs, Marney Butler-Jones here. Postal and payment details are included on the form.

Application For Membership

First Name

Last Name

I am a direct descendant of?

The descendant must have resided in the Port Phillip District of New South Wales (the present state of Victoria) prior to July 1, 1851.

My relationship to the above pioneer is:

My Contact Details

Address Line 1

Address Line 2

City

State

Postcode

Country

Telephone

Mobile

Details of Earliest Pioneer From Whom Descent is Claimed

Surname

Given Names

Date and Place of Birth:

Date and Place of Marriage:

Date and Place of Death:

Occupation

Arrival or Earliest Known Date in Port Phillip District:

Vessel or other proof:

Parents: Father

Parents: Mother

Details of Spouse

Surname

Given Names

Date and Place of Birth:

Date and Place of Death:

Occupation

Arrival or Earliest Known date in Port Phillip District:

Vessel or other proof:

Parents: Father

Parents: Mother

Children Accompanying Parents (Given Names and Ages)

Died: Date & Place

Type of Proof Supplied

Please send all relevant proofs required for your application to eop@pppg.org.au after submitting your membership application.

I declare that the statements made by me are true and correct.

I agree that ONLY the information and detail contained in Birth, Death and Marriages Certificates and other documents supplied by me in relation to my Port Phillip Pioneer Ancestors, may be extracted and added to the PPPG records. I understand that details submitted concerning other generations of my family will not be used by PPPG for inclusion in any accessible document.

Application For Membership of the Port Phillip Pioneers Group

My Contact Details

Details of Earliest Pioneer From Whom Descent is Claimed

Details of Spouse

Children Accompanying Parents (Given Names and Ages)

STATEMENT OF LINEAL DESCENT.

1)

2)

3)

4)

5)

6)

7)

PORT PHILLIP PIONEERS GROUP INCORPORATED

Address

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