FORM FOR ADDRESS / PHONE / E-MAIL CHANGES
Last Name: ______________________________ His: _________________ Hers: _______________
NEW ADDRESS
Street / PO Box: ___________________________________________________________________
Town / City: _____________________________ State: ______________ ZIP Code: ____________
NEW PHONE
Home Telephone: (_____) _______________________
Cell Phone(s): His (_____) ________________________ Hers (_____) _______________________
NEW E-MAIL
E-mail: __________________________________________________________________________
OLD ADDRESS
Street / PO Box: __________________________________________________________________
Town / City: _____________________________ State: _____________ ZIP Code: ____________
OLD PHONE
Home Telephone: (_____) _______________________
Cell Phone(s): His (_____) ________________________ Hers (_____) ______________________
OLD E-MAIL
E-mail: __________________________________________________________________________
(Please print CLEARLY and EXACTLY the way you want it)
--------------------------------------------------(
clip here)---------------------------------------------------Mail to:
Jan Woods, PO Box 2217, Florence, OR 97439-0145
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