Name
First Name: _______________________ Initial: _______ Last Name: ________________________

New Name or Address

 

First Name: _______________________ Initial: _______ Last Name:  _______________________

 
Street: _________________________________ Apt/Lot: _______

 
City: __________________________________ State:      ________ Zip: _______________

 

 

Phone: ______________________

 

E-Mail: ____________________________________________________________________________
 

 

*MEMBER’S SIGNATURE _________________________________________________
                                                                                                                                      * (Required)

 

Please fill the form out, print, and send to P.O. Box 188 Mayville, Wisconsin.


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For Office Use Only

 

Date Received: ____/____/________

Received By: ____________________________________________________________