Removal Form

Please send the following information to [email protected].
Your name will be removed from the Perspectives mailing list but will remain in our files for statistical purposes.



Today's Date:

Member ID number (found above your name on the Perspectives mailing label, if unsure, please leave blank):

Please enter FULL Name and Address as it appears on mailing label.

First Name: 
Maiden Name:
Married Name:

Address Line 1:
Address Line 2:
City: 
State:
Zip Code:

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Please site reason for requesting removal? (i.e. No longer interested in receiving Perspectives, Member Deceased, etc.)
 

Comments, concerns, etc.
 
 

Please tell us how to get in touch with you:

Your Name (if different from above):
Your E-mail:


Revised: March 26, 2002
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