Kanwa tho Lodge Personal Information Correction Form
Please use this form if you need to update or correct your personal information for the lodge database.
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Personal Contact Information
The following fields are optional, please ONLY enter information if it needs to be corrected or updated.
Street Address
Your answer
City
Your answer
State
Your answer
ZIP Code
Your answer
Personal Phone Number (for the individual)
Your answer
Alternate Phone Number (parent, alternate phone, etc.)
Your answer
Personal Email Address (for the individual)
Your answer
Alternate Email Address (parent, alternate email, etc.)
Your answer
Unit Information
Please enter unit information if it needs to be corrected or updated.
Unit Type
Unit Number
Your answer
In Which District Do You Live?
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If you have further questions about correcting or updating your personal information for the lodge database, please contact Joe Hauser, Communications Adviser, at joehoose2700@yahoo.com.
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