Member Update Form

Fall 2021

We are in the process of updating our database to ensure that we have correct addresses and other information for each of our member households. We are asking that one representative of each household complete the following questions. All information is voluntary. Responses will be utilized to update our membership records database and will not be shared or released for any purpose.

Name of Member Completing Form*
Prefix First Middle Last Suffix
Household Address
Street Address Address Line 2 City State ZIP Code
Gender (of member completing form)
- Male
- Female
Date of Birth (of member completing form)
Preferred Email (of member completing form)
Preferred Phone (of member completing form)
Type of Phone
- Mobile
- Home
- Work
Emergency Contact
Please provide the name and phone number of who we should contact in case of an emergency.
Additional Household Members
Please list Name, Date of Birth, Gender and Household Position for all additional household members. For adult members of the household, please also include phone number and email address.
Example: Joy Smith, 12/12/2016, Female, Child