OAMR Membership Change of Information

Instructions: Highlight and "Copy" the change of information form, click on the "Membership Committee Chair Vicki Nogle, Internet Committee Chair Deanna Gregory and Newsletter Chair Ruth Post" link to open e-mail message, and "Paste" the form into your e-mail message. 

1. Fill out the required areas (*) in both the old and new sections
2. Fill in the incorrect information in the old section
3. Fill in the correct information in the new section 
4. Subject line should read "Membership change information"

Send form to:  Membership Chair Stacie Cook

Old Information: 

Name*: ________________________________________________________________

Title:  __________________________________________________________________

Jurisdiction*: ____________________________________________________________

Address: _______________________________________________________________

Phone:  ________________________________________________________________

FAX: _________________________________________________________________

E-Mail: ________________________________________________________________

Website URL: ___________________________________________________________

New Information

Name*: ________________________________________________________________

Title:  __________________________________________________________________

Jurisdiction*: ____________________________________________________________

Address: _______________________________________________________________

Phone:  ________________________________________________________________

FAX: _________________________________________________________________

E-Mail: ________________________________________________________________

Website URL: ___________________________________________________________