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Member Update          
Keystone Wings members:
Use this form to provide - and update - your information.
When you click on the "Submit" button,
an email is sent to the Assistant Chapter Director/Webmaster.
Your personal data is collected and used only by your Chapter, for Chapter business.

 

HIS FIRST NAME 

HIS MIDDLE INITIAL 

HIS LAST NAME 

 

 

HIS STREET ADDRESS 1 
HIS STREET ADDRESS 2 
HIS CITY 
HIS STATE 
HIS ZIP 

 

 

HIS EMAIL ADDRESS 
HIS ALTERNATE EMAIL ADDRESS 

 

 

HIS HOME TELEPHONE 
HIS WORK TELEPHONE 
HIS CELLULAR TELEPHONE NUMBER 

 

 

HIS BIRTHDAY 

 

 

HIS MOTORCYCLE YEAR 
HIS MOTORCYCLE MAKE 

HIS MOTORCYCLE MODEL 

HIS MOTORCYCLE COLOR 

 

 

HER FIRST NAME 

HER MIDDLE INITIAL 

HER LAST NAME 

 

 

HER STREET ADDRESS LINE 1 

HER STREET ADDRESS LINE 2 

HER CITY 

HER STATE 

HER ZIP 

 

 

HER EMAIL ADDRESS 

HER ALTERNATE EMAIL ADDRESS 

 

 

HER HOME TELEPHONE NUMBER 

HER WORK TELEPHONE NUMBER 

HER CELLULAR TELEPHONE NUMBER 

 

 

HER BIRTHDAY 

 

 

HER MOTORCYCLE YEAR 

HER MOTORCYCLE MAKE 

HER MOTORCYCLE MODEL 

HER MOTORCYCLE COLOR 

 

WEDDING ANNIVERSARY 

 

 

NAMES OF DEPENDENT CHILDREN LIVING AT HOME

(Please include birthdays in parentheses) 

 
 
 

 

 

ANY OTHER INFORMATION (OR NOTE)

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