Member Contact Information Change Form

Update Member Information Here

Please take care to notify Civitan International of any contact information changes of a Civitan member – most importantly, e-mail address, to ensure members receive International communications.

PDF Change Form

Member Information Change Form

Submitted By:(Required)

Name of club member completing this form

First Last

Submitter's Email Address(Required)

Form confirmation will be sent here

Civitan Club(Required)

Member's New Contact Information

Member Name(Required)

First Last

New Preferred Email(Required)

Phone Type

New Phone Number(Required)

New Preferred Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country