CT COLT Membership Update Form

We would like to keep our membership records up-to-date in order that  that you will receive all our mailings.  It is important that we have your correct name and address for this to be accomplished.

Please complete the following form to change your preferred mailing address, school/home address, e-mail address or to inform us of a name change.

Date: 

Name: 

Previous Name (for name changes only): 

E-Mail Address: 

Which mailing address do you prefer? 

SCHOOL INFORMATION

School Name: 

Street Address/P.O. Box #: 

Town:     State:     ZipCode (9 digit, if possible): 

School Telephone:  Area Code   Phone Number  Extension: 

HOME INFORMATION

Street Address/P.O. Box #: 

Town:     State:     ZipCode (9 digit, if possible): 

Home Telephone:  Area Code  Phone Number 

Comments/Questions: 

Thank you for your assistance in keeping our records updated.

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