JOIN SEANC

Home

Change of District Request

 

(To transfer your membership to SEANC25:

complete, sign, and return this form to

Tommy Griffin, CB1800,

 Carolina Campus)

 

 

 

Name (please print):______________________________________________

 

SSN:_______________________________________________________

 

Transfer my membership from District # _____(if known) toDistrict #25

 

 

_____________________________________    _______________________

Signature                                                                Date

 

 

If you prefer not to supply your SSN, you may contact:

 

SEANCís Central Office in Raleigh:

 

Local Phone: (919) 833-6436

Toll-free Phone: 800-222-2758

Regular office hours are Monday-Friday from 8 a.m.-5 p.m.

st modified 5/15/09