Lost Members Form

(Please complete a separate form for each name you can identify.)

Lost Members Form

Your Name:

Your Phone Number (in case we have additional questions):

1. Lost Member Name (as it appears on the list): *

2. Is this member:

Living (continue to question 3)

Deceased (continue to question 4)

Unknown (please answer question 3 or 4 to the best of your knowledge)

3. If living, please provide the lost member's current address and phone number (if known):

4. If deceased, please provide the name, address, and phone number of the person responsible for the lost member's estate (if known):

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If you are human, leave this field blank.

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