Heir
Individual Change Form


If your information has changed, please let us know!

First, in the "Existing e-mail, phone, address, name, etc." box below, we need enough of your existing information to uniquely identify you among all those already in our database. E-mail addresses, phone numbers, and addresses are sufficient unless you are sharing them with someone who is registered separately. Name may unexpectedly be insufficient. Please allow for the possibility that we don't have as much information as you think you gave us. Some people haven't been getting our e-mail updates because we deleted their e-mail address after finding it unusable.

Existing e-mail, phone, address, name, etc.:

Second, enter only your changed data or what you think we may not have. If any of the data we might already have should be deleted from the database, then please enter three asterisks in a row - "***" - in the corresponding box:

Name:

I am interested in attending HEIR meetings in the Atlanta area:
Unchanged
Yes
No

Email (something like xxxxx@xxxxx.com or .net - "@" required):

Phone: Area: Number:
FAX: Area: Number:
County: (e.g. Fulton or Hall)

Postal Address:
Name (if different than above):
Line 1:
Line 2:
City: State: Zip:

Support Group Name:

I'd like to volunteer for:

Newsletter Editor:
Unchanged
Yes
No

Assist with newsletter:
Unchanged
Yes
No

Assist with coordinating activities (fairs, local workshops to inform about HEIR and HEIR issues, etc.):
Unchanged
Yes
No

Assist with paperwork:
Unchanged
Yes
No

Assist with research:
Unchanged
Yes
No

Other:
Unchanged
Yes, specifically:
No

Communcation Network (click here for descriptions):

District Coordinator:
Unchanged
Yes
No

Sub-District Coordinator:
Unchanged
Yes
No

County Representative:
Unchanged
Yes
No

HEIR Ambassador:
Unchanged
Yes
No

Third: or

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Modified 06/12/99
© 1997, 1998, 1999 HEIR