Membership File Information

Thank you for taking the time to complete this form. It is vital that we have the most current information on file for our members. Please fill out the information as completely as possible. When you are finished, simply click the “Submit” button at the bottom of the form, and your information will be automatically sent to our office. Please call us at (715) 423-2230 with any questions.

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary/Winter Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Email Address, Primary

Email Address, Secondary

Place of Employment

Name, Spouse/Significant Other

First Name

Last Name

Date of Birth, Spouse/Significant Other

MM

DD

YYYY

Primary Phone, Spouse/Significant Other

(###)

###

####

Email, Spouse/Significant Other

1. Dependent (under age 25)

First Name

Last Name

Date of Birth

MM

DD

YYYY

2. Dependent (under age 25)

First Name

Last Name

Date of Birth

MM

DD

YYYY

3. Dependent (under age 25)

First Name

Last Name

Date of Birth

MM

DD

YYYY

4. Dependent (under age 25)

First Name

Last Name

Date of Birth

MM

DD

YYYY