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Member Information Change Forms
______________________________________________ ___ ____ ____ ________
Club Name
State
Dist. No. Zone No. Club No.
____________ _____________________________________
(date submitted) (submitted by)
Change CODES:
AL - At Large Member
AM - New Associate Member
AMR - Associate Member renewing
AR - Associate Member becoming an Active Member
D - Active Member Dropped
E - Active Member Deceased
F - Former Member Reinstated
H - Honorary Member
L - Leave of Absence
N - New Active Member
RA - Active Member moving to Associate
RH - Active Member moving to Honorary
RS - Ruritan Student Program or Youth Member in a
Regular Club
T - Transfer from Another Clu
b
YA- Youth to Adult Member
Changes can be made directly to your club data on line through the Ruritan Member Management System
(
MMS
) or marked on the membership
Audit and Invoice Report
that is mailed from the Ruritan National Office
monthly. For directions on using the
MMS
see page five of this handbook.
However, you can also update records by recording changes on this form and sending to P.O. Box 487,
Dublin, VA 24084. Use the codes listed above to show what changes have been made. Remember that Ruritan
Forever is not a membership type - but rather a payment option for all membership types. This form is also
available on line at
http://ruritan.orgunder “resources”.
Codes
Use extra sheets of paper if you have more changes.
See above
Name
Street/Box #
City
State Zip
Please list any forwarding addresses for members dropped above.
Name
Street/Box #
City
State Zip
Please list any club officer changes that apply this month.
Change Name
Street/Box #
City
State Zip
Please list any address changes for club members below.
Name
Street/Box #
City
State Zip
Old Address
New Address
Old Address
New Address
Please list any changes in club officers.
Office Held
Name
Street/Box #
City
State Zip