Member Information Form - Change of Address

		Old Address/Contact Information (* required fields)   * Prefix: Mr. Mrs. Mr. & Mrs. Ms. Dr. * Name: * Address: Address: * City: * State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY * Zip: * Home Phone: Work Phone: E-Mail:   Current Residential/Contact Information (* required fields)   * Prefix: Mr. Mrs. Mr. & Mrs. Ms. Dr. * Name: * Address: Address: * City: * State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY * Zip: * Home Phone: Work Phone: Cellular Phone: * E-mail #1: E-mail #2:   Please contact us again when you wish to change back to your original address or obtain a new permanent address.       Do you wish to receive WYES e-mail update newsletters (when available): Yes No Do you wish to receive WYES special event information (when available): Yes No Do you wish to receive WYES Volunteer info: Yes No Comments:   Contact us at: WYES-TV P.O. Box 24026 New Orleans, LA 70184-4026 membership@wyes.org