Form for Membership Directory & IHC Records

Please take a few minutes to complete this form by August 5. Only one person per household needs to complete this form.

Doing so will allow us to make sure the information we have for you is current in our membership records and will be used for our new membership directory. We ask you to complete every applicable field. At the end, you may tell us what information you do not want published in the directory.

Individual Adult or Family Name(s), Last, then first*

Please tell us how you want to be listed, for example: if you are a couple (of any variety): Goldberg, Morty and Esther or if you have different last names: Goldberg, Morty and Feinstein, Esther or if single: Cohen, Gladys. Any children in the household will be listed below. For consistency in the directory, we will decide the order of the first names when the last name is the same.
Street Address (Main Address for Directory Listing)
City
State
Zip Code
Secondary Address

Please complete this section if you want mail to be sent to this address during certain months of the year (ie vacation home). If not, just skip.
City
State
Zip Code
Months to receive mail at this secondary address
Home phone number (if you still have a landline)
Secondary (Vacation) phone number

If you use your cell phone number there, please let us know.
Adult 1: Last Name
Adult 1: First Name
Adult 1: Birthdate
MM slash DD slash YYYY

Don't worry, this is for internal use only, not the directory.
Adult 1: Mobile phone number
Adult 1: Email address
Adult 2: Last name
Adult 2: First name
Adult 2: Mobile phone number
Adult 2: Email address
Adult 2: Birthdate
MM slash DD slash YYYY

Don't worry, this is for internal use only, not the directory.
Wedding Anniversary Date (if applicable)
MM slash DD slash YYYY

Don't worry, this is for internal use only, not the directory.
Child #1 living at home: name, first and last
Child #2 living at home: name, first and last
Child #3 living at home: name, first and last
Child #4 living at home: name, first and last
Child #5 living at home: name, first and last
Child #6 living at home: name, first and last
List any of the fields you do not want published in the directory

Adult names will be printed, but if you do not want one or more of your address, home phone, mobile number(s), email address(es) and children's name(s) printed, please specify here. It is important that you complete ALL of the above applicable fields in this form so we can make sure your information is correct and complete in our membership records, even if you do not want the information included in our directory. Thank you for helping us with this important task.

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