Name of Church:______________________________Location:______________________________

Did you write history for all departments of the church? Yes No
Number of communicant members in the church?_____ Number of children?_____ Number of non-communicants?_____
Or for the Women in the Church only? Yes No Number of Women in the church?_____How many Circles?____

Did you include:
Names of Births?Yes No How many?__________
Names of Baptisms?Yes No How many?__________
Names of Marriages?Yes No How many?__________
Names of New Members?Yes No How many?________
Names of Deaths?Yes No How many?__________
Names of Dismissals to other churches?Yes No How many?__________
Did you supplement your history with bulletins, newsletters, clippings, pictures, memorials, etc.?

Did you have the Session review & approve your completed history? Yes No [Please take care to have this done.]

Are you on the mailing list of the PCA Historical Center, and do you receive their newsletters?Yes No
Does your church include the PCA Historical Center in its annual budget?Yes No
Does your WIC include the PCA Historical Center in its annual budget? Yes No
Will you encourage your church, your WIC, and individuals to support the Historical Center with their prayers, as well as their money which is so vitally needed?

How do you share your completed history with your congregation and/or your WIC?

Have you any suggestions to pass on to other church historians and/or WIC historians that will be helpful in their work?

My completed history was mailed to the PCA Historical Center, 12330 Conway Road, St. Louis, MO 63141
A copy was kept for my church's records and/or the records of the Women in the Church

Copies of this form may be completed and sent, as needed, to:
The PCA Historical Center
The Session of your church
Your WIC Presbytery's appointed representative:___________________________________________________

Local Historian's name & address:
_____________________________
_____________________________
_____________________________