Address/Membership Status Change

Address/Membership Status Change

• Required

First Name
•

Last Name
•

Email Address
•

Previous address, city, state, zip

New address, city, state, zip

If this is a permanent address change, please list the effective date

If this is a temporary address change, please enter change effective dates -- from date to date

Current phone number

New phone number

Please
Continue all mailings/emails
Stop all mailings/emails

List all names moving to new address

Request to change membership to: (please list church name, address and effective date).

Request to drop membership (please enter yes/no). If yes, please enter reason.

Change in marital status (please enter separated / divorced / marriage / other).

Any changes required in pledge or contribution information?

Other?