Would you like to include information on your heirloom(s) in the R-CA Heirloom Library. If so, just complete and submit the form below. Please include your name and contact information and the following information (if known) about the heirloom(s) and a photo(s) of your heirloom. Please complete a separate form for each heirloom you would like to include in the Library. 

Your Name:__________________________________________________________________________________
Email Address: ______________________________________________________________________________
Phone:_______________________________________________________________________________________

1. Description of the heirloom (what it is, how old it is, condition, how was it used, how long
   it was used by the original owner, and any other distinguishing or interesting features).

______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

2. Original owners name and when and where the heirloom was purchased or obtained.

______________________________________________________________________________________________
______________________________________________________________________________________________

3. Current owners name and when it was gifted to or purchased by the current owner.

______________________________________________________________________________________________
______________________________________________________________________________________________

                     Paste photo(s) of your heirloom and past and/or current owners here.

Please copy or print this form and then email your form to BoD@Roark.Conner.org.