Update Contact Information

Update Contact Information

This form may be used to update your contact information for the Benton County Dems mailing list and. if you are also a member, for the BC Dems membership roster. A copy of this change information will be sent to both the maintainer of our Mailchimp list and to our Membership Chair, who maintains the roster.

You may enter new values for one or more items: Email, Telephone, Address. If submitting a new value, please also include the old contact value to insure this change is associated with the correct individual.

* Indicates required field

Name *

First

Last

Complete at least one of the following change sections, old and new values.

Old Email *

New Email *

Old Phone Number *

New Phone Number *

Old Address *

Line 1

Line 2

City

State

Zip Code

Country

New Address *

Line 1

Line 2

City

State

Zip Code

Country

Comment *

Submit