National Order of Trench Rats
MEMBER INFORMATION/
CHANGE OF ADDRESS REPORT
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ADDRESS CHANGE DECEASED MEMBER
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DUGOUT: ___________________ DATE: ____________________
MEMBER'S LIFE MEMBER NUMBER ____________________
MEMBER NAME: _____________________________________________________________________________
OLD ADDRESS: _____________________________________________________________________________
CITY : __________________________________________STATE:_____________ ZIP_____________________
NEW ADDRESS: ____________________________________________________________________________
CITY : __________________________________________STATE:_____________ ZIP_____________________
PHONE NUMBER (________) _____________________________
Mail this form to Imperial Headquarters at:
National Order of Trench Rats
Imperial Headquarters
PO Box 1068
Kingston PA 18704-1068
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