Guest Questionaire

re: Q-Files - Personal Biography Questionnaire Deposit Example

This is a facsimile of the original questionnaire which was used in assembling the information for the book."Who's Who in Central & East Europe 1933"which was published in Zurich in 1934.

The main contents of the "Memory Arena" Archive is formed by biographical fragments found in this book, as well as Questionnaires which have been collected in previous "Memory Arenas". We now have over 700 questionnaires from the installations inHamburg, Munich and Copenhagen. We collect these questionnaires on-site during the "Memory Arena" opening hours at theArchive Administration Areaand on Computers within theHypertext Installation. When you have no objections to the availability of this information within the Installation, please fill out the following Questionnaire. You may give only the information which you wish.

First Name: ___________________________________________ Last Name: ____________________________________________ Profession: ___________________________________________ Birthdate: ____________________________________________ Birthplace: ___________________________________________ City: _________________________________________________ Country: ______________________________________________ City of Residence: ____________________________________ City: _________________________________________________ Country: ______________________________________________ Father: _______________________________________________ Last Name: ____________________________________________ First Name: ___________________________________________ Profession: ___________________________________________ Mother: _______________________________________________ Last Name: ____________________________________________ First Name: ___________________________________________ Profession: ___________________________________________ Ancestors (List or describe any interesting Ancestors): _______________________________________________________ _______________________________________________________ _______________________________________________________ Marriage: _____________________________________________ Date: _________________________________________________ Profession: ___________________________________________ Education: ____________________________________________ Publications (List if any): ___________________________ Political Party Membership: ___________________________ Organizations Membership: _____________________________ Awards and Honors: ____________________________________ Collections (List): ___________________________________ Hobbies: ______________________________________________ Additional Information, etc.: _______________________________________________________ _______________________________________________________ _______________________________________________________ I agree that this information will be included in future "Memory Arena" Projects.

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