Enter your birthdate below. When entering your birthdate, please use 2 digits for month , 2 digits for day, and 4 digits for year. Example: 02 06 1966.

In the full name at birth box kindly enter the full name (first, middle and last) as indicated on your birth certificate. If there are more than one middle names, include them all. If you are a Jr. (i.e. John Andrew Smith Jr.) it would be entered as John Andrew Smith Junior. John Smith II would be entered as John Smith The second. Or, John Jones IV would be John Jones The Fourth. Then you will fill out the current name used box by following the instructions as given below.

In the my current name box you will enter the current name you use on a daily basis (first and last). The book will be prepared especially for you. For example, your full name at birth name may be Mary Ellen Jones. Currently you use Mary Jones. Or you might use your married name, Mary Smith. Perhaps you use an individualized name such as Crystal Smith. Perhaps you were born Robert Sherwood Oliver Now you use Bob Oliver. If you use three names or more on a daily basis enter them all.