Membership Change Request

Use the form below to enter your new membership information. Enter tall requested information, even if it remains the same. Please allow a couple weeks for changes to be processed. Use this form to change your address, email, phone or chapter.

Membership Change Request

Used to allow members to submit changes such as address, phone, email or chapter.

Member's Full Name(Required)

If couple, other member’s name:

What are you changing?(Required)

Membership number: found on your membership card or mailing lable of your "Between the Lines" newsletter.(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:(include your area code)(Required)

Email(Required)

Select Chapter(Required)

How would you like to receive your "Between the Lines" (BTL) newsletter?(Required)

Any special instruction (Optional)

Name

This field is for validation purposes and should be left unchanged.