Update RSC Member's

Contact Information Form

E-mail Address(es):

Telephone Contact Information: (Format: (xxx) xxx-xxxx)

RSC E-mail Message preference: (Check one box below)

Effective Date:

Member Name:

Street Address:

City:

State:

Zip Code:

PO Box Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Work Phone:

Home:

Work:

RSC Newsletter Distribution Preference:

Past Club Offices Held & Recognition Awards Received from the Richmond Shag Club:  (Please complete, if appropriate)

RSC Phone Tree Automated Messages: (Check one box below)

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Preferred for Club Phone Tree Use

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