Archive Appointment Request Form

Name *

First Name

Last Name

Phone *

(###)

###

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Collections Requested (please check all that apply) *

Alnwick Records

Haldimand Records

Other

Please select your first choice for the date of the appointment *

MM

DD

YYYY

Please select your first choice for the time of the appointment *

Hour

Minute

Second

AM PM

Please select your second choice for the date of the appointment

MM

DD

YYYY

Please select your second choice for the time of the appointment

Hour

Minute

Second

AM PM

Please select your third choice for the date of the appointment

MM

DD

YYYY

Please select your third choice for the time of the appointment

Hour

Minute

Second

AM PM