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2. ID Number:*
4. Member First Name*
5. Member Last Name*
7. Member Job Title*
8. Member Work Phone Number*
10. Municipality*
11. State/Province*
12. Country
14. Member Email Address*
18. Which of the following do you need to update?*

    1. I need to update my municipality information
    2. I need to update my personal information.
20. Which of the following municipality information needs updated? If you are moving to a new municipality, provide full contact information.*

    Check all that apply.

    1. Name
    2. Title
    3. Municipality
    4. Work Address
    5. Work Telephone
    6. Work Fax
    7. Work Cell Telephone
    8. Work Email Address
    9. Web Address
    10. Population
22. Which of the following personal contact information needs to be updated?

    1. Name
    2. Home Address
    3. Home Phone
    4. Personal Cell Phone
    5. Home Email Address
24. New Municipality*
26. Municipality You Are Leaving*
28. Did you Replace Someone in your New Municipality?*

    1. Yes
    2. No
30. Please Enter Name of Replaced Employee*
32. Current Name on Membership*
34. Your New Name*
    This is for name changes and not employee changes.
36. Title Change*
38. Full Work Address Change*
40. Work Telephone Change*
41. New Work Fax Number*
43. Web Address Change*
45. Home Address Change*
47. Home Telephone Change*
48. New Work Cell Number*
50. New Work Email *
51. New Personal Cell Number*
53. Population Change*
54. New Home Email*
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field