Change of Address Form

 
If you have had a change of address or phone number, you can submit your new information to the Membership Committee via this form.  Without your proper contact information, we can not mail your copy of Wolf's Tale or your membership cards.  Please provide your current member ID number and date of Ordeal (found on your new membership card) to validate the information received is genuine.

Please enter your updated information below.  Fill in fields as completely and accurately as possible before submitting.  Required fields are  indicated with an asterisk ( * ).

Lodge ID#   * ( Found on membership card or mailing label )
Full Name   *
Address Line 1   *
Address Line 2  
City   *
State   *
Zip Code   * ( Example: 12345 or 12345-6789 )
Home Phone #   * ( Example: 570-555-1212 )
Work Phone #  
E-mail Address  
Unit  ( Example: T-123 )

To verify your identity, please enter your Ordeal Date as found on your membership card.

Ordeal Date

   ( Example: 2004/05/23 )

Last Update: 05/26/06