ROTARY CLUB OF HARTFORD NO. 21 

Informational Update Form

 

Please take the time to complete this form and mail to:

 

Rotary Club of Hartford

P.O. Box 508

Hartford, CT 06141

 

We are making a concerted effort to update our records. Thank you!!!

 

Name:

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Nickname:

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Home Address:

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Business Address:

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Home Phone:

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Bus. Phone:

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Home Fax:

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Business Fax:

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E-Mail 1:

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E-Mail 2:

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Cell Phone:

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Job Title:

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Previous Living Locations:

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Years in Present Position:

_____

Years Resident in Greater Hartford:            ________

Date of Birth:

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Place of Birth:

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Martial Status:

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Spouse Name:

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Date of Marriage:

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Number of Children:

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Education (Degrees, Dates, Institutions):

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Date of Induction:

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