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THE TREASURE COAST JEWEL A Brotherhood Against Totalitarian Enactment
American Bikers Aiming Toward Education
FEBRUARY, 2014
VOLUME #6 ISSUE #2
THE NEXT CHAPTER MEETING
February 26 @ 7:00pm
American Legion Post No. 189
807 Louisiana Avenue, Sebastian
ABATE IS NON-PARTISAN AND WELCOMES ALL RIDERS
MEMBERS OF NCOM and MRF
OFFICERS
CHAPTER POSITIONS NAME PHONE # EMAIL ADDRESS
PRESIDENT STEVE KLIEMISCH 772-778-8130 [email protected] VICE PRESIDENT SUE HULCE 772-480-4776 [email protected]
SECRETARY
TREASURER
SERGEANT AT ARMS DALE GASPARIK 772-260-3880 [email protected]
MEMBERSHIP TRUSTEE SUE HULCE 772-480-4776 [email protected] PUBLIC RELATIONS WENDY CAPOTOSTO 321-537-8964 PRODUCTS TRUSTEE TIM FLYNN 772-581-9544 [email protected] SAFETY TRUSTEE JOHN BUTLER 440-666-5527 [email protected]
LEGISLATIVE TRUSTEE STEVE KLIEMISCH 772-778-8130 [email protected] STATE DELEGATES STEVE KLIEMISCH, OPEN COMMUNICATIONS TRUSTEE LIZCA MATHIS & ED YOUNG 772-473-9385 [email protected] ROAD CAPTAIN DARREN “WIZ” CAPOTOSTO 321-506-3078 [email protected] CHAPLAIN KIM "Shep" GEMEINHARDT 772-913-5549 [email protected] NOTARY PUBLIC ED PARKER 321-537-9282 [email protected]
STATE BLOOD BANK ACCOUNT
#1138
COUNTY BLOOD BANK ACCOUNT
#VABT
CHAPTER EMAIL [email protected] CHAPTER WEBSITE UNDER CONSTRUCTION
TABLE OF CONTENTS
Calendar 12 LIST OF ADVERTISERS
Acorn Storage 8
Disclaimers 3
Flyers 13-18
Dog House Lounge 5
Earl’s Hideaway 11
Jeff Mathis Services & Metal Works 8
Membership Report 7 Perfection Auto Service 8
Membership and Renewal Application 21
Milestones 10 Minutes 4,5 V Twin Concepts 8
Officers (State & Chapter) 19 & 2
President’s / Vice President’s Report 6
State and District Reps 20
666
Information for Business Ads
TREASURE COAST CHAPTER RESERVES THE RIGHT TO EDIT ANY CONTENT POSTED IN THIS
PUBLICATION.
Advertising Procedure: ALL ADS MUST BE PRINT READY. Email ads to: [email protected] Newsletter Deadline
Ads must be prepaid to ”ABATE of Florida, Treasure Coast Chapter” and submitted no later than the 20th
OF THE MONTH to make the next month’s issue. The advertiser is responsible for all copy and ad changes.
Advertising Rates for Business Ads
FULL PAGE $282.48 HALF PAGE $141.24
QUARTER PAGE $77.04 BUSINESS CARD $38.52
All advertising rates above are for six (6) months.
FULL PAGE (ONE TIME) $69.55
Goals and Purposes of ABATE
TO issue a newsletter to keep all bikers informed with regard to legislative actions and events around the state and throughout the country. TO become a powerful and viable political force in legislative matters concerning all motorcyclist’s rights. TO provide a lobbyist to represent ABATE of Florida, Inc. on the state and national level. TO promote voter registration and motivate members to write their legislators. TO promote safe riding habits without infringing on the individual rights.
TO educate the public about motorcycle awareness.
How Does ABATE accomplish its goals?
ABATE of Florida Inc. is a non-profit, grassroots political corporation composed of local chapters that have been
organized by motorcyclists, to promote a positive image through local, civic, charitable and benevolent causes; pooling
resources for the common benefit of the members and promoting political awareness. ABATE exists to monitor legislation
and testifies in your behalf during Senate and House hearings. ABATE collects, processes and exchanges information that
may concern you or substantiate our views and places it in your hands through a newsletter or by other means of
communication. Who Can Join and Why?
Any individual 18 years or older interested in motorcycle rights, regardless of their race, sex or club affiliation.
It doesn’t matter what you ride or even if you ride. To join ABATE ensures YOUR opinion on motorcycle laws
will be heard. Membership Benefits:
As a member of ABATE you may receive discounts on products such as:
1 Motorcycle parts and accessories (from participating dealers)
2 ABATE runs, events and functions
3 Motorcycle safety school for endorsements on your Florida license 4 You also receive a STATE and CHAPTER newsletter.
Newsletter Disclaimer: This publication exists to inform its readers of legislation, events and activities pertinent to motorcycle enthusiasts concerned with freedom of choice. We
encourage submission to be in good taste, true in content, and free of libelous or slanderous statements. However, the views expressed may not be those of
ABATE of Florida Inc. and its Board of Directors, or that of the Treasure Coast Chapter.
NOTE: Contributions and gifts to ABATE of Florida Inc. are not tax deductible. DISCLAIMERS The views and opinions expressed in this newsletter are not necessarily that of ABATE of Florida, Inc. or the Treasure Coast Chapter. This Publication encourages the views and opinions of its members and sponsors. ABATE of Florida, Inc. and Treasure Coast Chapter accepts no responsibility for opinions, views and/or comments in this publication. The Editor reserves the right to edit for length, Misspellings, formatting and inappropriate language.
ABATE OF FLORIDA, INC. AND THE TREASURE COAST CHAPTER DOES NOT
CONDONE DRINKING AND RIDING/DRIVING.
Identification Statement
Publication Title:
The Treasure Coast Jewel Issue Date: Volume #: Issue #:
February , 2014 6 2
Statement of Frequency:
Published Monthly Name and Address:
ABATE of Florida, Inc.
Treasure Coast Chapter P.
PO. Box 1360
Roseland, FL 32957-1360
Have something to sell? Need to have it and can’t find it?
We have space for FREE for members to post. Just email our chapter at
[email protected] with your classified request and we will post it AFTER APPROVAL.
All information must be in by the 20th of the month to be published in the next month newsletter.
TREASURE COAST ABATE GENERAL MEETING
JANUARY 29, 2014
The President called the meeting to order 7:05 p.m.
PRESIDENT’S REPORT:
Thanked everyone for coming.
At the Board of Director’s meeting last week, we set up a calendar of events. The calendars available on our web
site. We missed the Frog Leg Festival and don’t want to do that again. We need volunteers for the Grant Sea Food
Festival on 3/1 and 3/2.
We have to get younger members who will be able to take over.
We need a Secretary. Anyone who is interested, please call me or Sue.
VICE-PRESIDENT’S REPORT:
The weekly messages I get from Tallahassee will be given to Ed for addition to web site. The State wants to take
the money we pay for registration that is supposed to go to education
SECRETARY’S REPORT:
Position open. There is no report.
TREASURER’S REPORT: January report read and accepted.
SARGEANT AT ARMS REPORT:
No report. Thanks everyone for their prayers for Laura.
CHAPLIN: February 9
th is special Valentine’s Day church. February 23 is monthly biker church. January’s bike day had a
good turn-out.
MEMBERSHIP:
Val resigned from the State. We are being audited by the State but are okay. We have 196
members, 6 new ones this month.
LEGISLATIVE:
The State wants to take part of your registration money to set up motorcycle only check points.
State meeting is 2/8 in Lake County. You don’t have to be a delegate to attend.
SAFETY:
John is not here tonight. We have a booth at the upcoming Grant Seafood Festival.
PRODUCTS: The new inventory list is done. We need long sleeved dark grey shirts.
NEWSLETTER:
We need birthdays and anniversaries for newsletter. Also, if you have something for sale or are looking to
purchase something, let us know. Lizca is putting our newsletter on her Facebook page. It will be good exposure
and maybe attract new members.
WEBMASTER:
Web site is almost finished. The front page, calendar, and Board of Directors finished.
BIKE WEEK 2014:
We have the campground in Deland for Bike Week. There will be full security. If you volunteer, hours can go
toward camping fees, meals, etc.
TALLAHASSEE:
Ride up April 12 and stay through Monday. April 13th
is the State Meeting. Monday, April 14th, we will be
speaking to our representatives. Politicians look at numbers. Think about joining us.
NEW BUSINESS:
We have a guest. His name is Ronald and he retired 10 years ago to Costa Rico.
This Saturday, February 1st, is the Friends and Family Memorial Ride.
The starting points are: TA Truck Stop on Rt. 60 at 9:30
Earl’s at 9:30
Desert Inn, Yeehaw Junction 11:00
This Sunday, 2/2, is breakfast at Doghouse. Not sure about riding, Super Bowl Sunday.
Feb. 23rd
is Fiasco Brothers Annual party at Filthy McNasty’s.
Meeting adjourned at 7:53 p.m.
Check on the traffic before setting out on your trip: http://www.flhsmv.gov/fhp/traffic
To Report Road Hazards
Indian River County: 772-770-5085 Brevard County: 321-690-6840
Vice President’s & Membership Report by SUE HULCE
WHO JOINED IN FEBRUARY...........IT’S TIME TO RENEW MEMBERSHIP by SUE HULCE I receive almost daily, various reports from Darrin “Scribes” Brooks, our State Legislature. These reports are very informative and keep you on your toes as to how much crap gets put in for a vote just because. Some are
important and some are ridiculous. Of course, that is my opinion. In any event, they will be available for viewing in the near future on our web page. Thanks to Ed Young who is doing a super job in getting it up and running. Please keep in mind the Grant Seafood Festival is coming up the first weekend of March. If any members can volunteer for an hour or two, it would be greatly appreciated. As a member of Abate and your Membership Trustee, I have listened to all kinds of reasons why members don’t renew. I can only stress, that believing in what Abate represents should be the reason you stay involved. It’s being kept abreast of the laws and bills that affect each and every one of us. $20 bucks and you have a voice, someone watching big government, not just for motorcyclists, but for everyone. Treasure Coast is your local chapter, not your only chapter. Don’t let personal differences stand in your way from being heard. Having said that, our membership stands at 196 members with 6 new members and 14 renewals. WELCOME TO TREASURE COAST: Gian DeCarbonaConti, James Wescott, Rob Keller, Bart Bruner, Tom Lockwood and Jim MacDonald. And of course, thank you to our renewing members for your continued support: Jack Davis, Jim Kandt, Peter Puzzo, Bud Murray, Larry and Donna Urban, Shelli Routon, Rodger Bolling, Betty Barber, Darren and Wendy Capotosto, Art Sheridan, Jeff Chandler and Neil Rutzen. The following memberships were lost in December: Edward Clarke, James Cole, Thomas Follen, Linda Gasparik, Ed Iron, Ed Kilbane, Bob Marshall, Nina McNab and Robin Pace. January Memberships expiring: Norman Barrett, Donald Battiste, Jeanne Bryant, Paul and Vicki Helwig, Lewis Herring, Dennis Mallon, Joe Ostrander, Kim Reno, Jamie Sanders-Butler and Paul Zminkowski. February Memberships coming up for renewal: Gabriel Calero, Monica Thompson, John Arnold, Patti and Wayne Bachman, Debbie and Wally Baldwin, Debbie Cross, Jack Deitemeyer, Tim Flynn, Jack Harrigan, Mike Jackson, Sharon Lee Napolitano, Robin Phillips, Patty Rutzen, Jeff Somers and Lee Dickens. REMEMBER – MEMBERSHIP IS EVERYONE – SUPPORT YOUR CHAPTER – THANKS!!
ABATE of Florida, Inc. Legislative Blueprint for 2014
This year I am going to try my best to offer up a bare bones blueprint for what ABATE of Florida, Inc. is striving to accomplish for both the 2014 legislative session and the following 2014 campaign season. I reiterate the word “bare bones” because I can’t help but think of the famous Scottish poet, Robert Burns, who penned “the best laid schemes of mice and men oft go awry, and leave us nothing but grief and pain, for
promised joy! " But, we are bikers and we know better than most that life holds no guarantees. Nevertheless
we strike out on our ride willing to brave whatever it is that the Fates throw our direction. The State Delegates have come to agreement that ABATE of Florida, Inc. should pursue the following legislative goals. These are offered in no particular order and are just a summary of the goals intentions: • Support for increased penalties for vehicle drivers that cause the death or bodily harm to motorcyclist and/or passengers via various traffic infractions. • Support for increased Drivers Education for new drivers. • Support for grant money that specifically comes from a portion of the registration fee paid when motorcyclist registers their motorcycle. The grant is used 100% for ABATE of Florida’s, Inc. Motorcycle Safety Awareness Program” which educates the public in motorcycle awareness with the purpose of decreasing vehicle vs motorcycle crashes. • Support legislation that will decrease “driver distraction” such as texting while driving and the use of hands-free devices. • Oppose Federal mandates that would increase the Ethanol percentage in gasoline. The E15 fuel has been repeatedly proven to adversely affect small engines such as motorcycle engines. • Oppose any and all Federal and/or State mandates that would adversely affect the freedoms that motorcyclist in Florida currently enjoys.
In regard to the 2014 campaign season for Local, State, and National offices, ABATE of Florida, Inc. will pursue the following areas: • Educate candidates running for public office about abate of Florida, Inc. and motorcycle rights. • Invite candidates to speak to our membership to promote awareness. • Seek out and support Motorcycle friendly candidates. • Educate the motorcycle community about motorcycle friendly candidates. ABATE of Florida, Inc. is Florida's largest Motorcycle Rights Organization with chapters across the State of Florida. We fight for the rights and safety of ALL motorcyclist and we would appreciate your support and invite you to join with us to help keep motorcycling free and safe. For more information about ABATE of Florida, Inc. please visit www.abateflorida.com Darrin "Scribe" Brooks, State Legislative Trustee, ABATE of Florida, Inc. www.abateflorida.com
ABATE of Florida, Inc. 5 Year Legislative Plan
Here is the bare bones 5 year legislative plan for ABATE of Florida, Inc. The purpose of the 5 year plan is to act as both a guide and a wish list for what we want to do and where we want to be in the near future. Because no one can see into the future, I offer my usual caveat stating that this is just a plan and subject to modification, rescindment, and/or addition. These are listed in no specific order. • Pass into legislation some type of enhanced penalties Bill for killing or injuring a motorcyclist. • Pass into legislation further enhanced distracted driver Bill. • Receive grant money each year for our Motorcycle Safety Awareness Program. • Increase participation at our yearly Freedom Rights Rally at the Capital in Tallahassee. • Develop a Political Action Committee that will pool campaign contributions from members / supporters and donate those funds to campaigns for or against candidates, ballot initiatives, or legislation. • Increase education and awareness to Local, State, and National legislators. • Oppose limitations on motorcyclist freedoms from Federal and/or State mandates. • Educate our members on proper communication with legislators. • Increase each Chapter’s ability to spur member participation in contacting legislators. • Increase support and participation for our legislative goals within the motorcycle community i.e.; motorcycle clubs, motorcycle rider organizations, etc. • Increase timeliness of distributing news affecting motorcycling to our members. • Provide prompt “position statements” to our members and media regarding motorcycling issues or current events. • Make ABATE of Florida, Inc. THE source for the media in Florida regarding motorcyclist issues. I plan for this to be a living, breathing document that is looked at and revised regularly. It will not be put away and left to collect dust. This plan is for EVERY SINGLE ONE of us, it will only succeed if we all work together. Henry Ford put it this way, “Coming together is a beginning; keeping together is progress; working together is success.” Darrin "Scribe" Brooks
ABATE of Florida $10,000.00 cash drawing tickets are out!
$5.00 per ticket (only 7,500 printed) 1 winner
Drawing to be held at the ABATE campground on Saturday March 15, 2014 at 12 noon
Need not be present to win. Must be 18 & have proper ID
For more information and tickets contact our chapter at [email protected]
We encourage our membership to send us any type of information to be included in our “FROM
OUR PEOPLE” section of the Jewel. If you have pictures, a story to share, a ride of a lifetime, etc. just email it by the 20th of
the month to be duplicated on the next month’s Jewel. Just email you pictures and story, preferably a jpg format for
pictures and Word for the text to [email protected]
We all would love to hear from you!
MEMBERS MILESTONES
HAPPY BIRTHDAY and HAPPY ANNIVERSARY TO ALL OF YOU CELEBRATING IN FEBRUARY!
PLEASE EMAIL YOUR ANNOUNCEMENTS TO [email protected] by the 20th
of the month prior to the milestone
:
ABATE Breakfast and Sunday ride every 1st Sunday of the month
At the Dog House Lounge Next date: FEBRUARY 2
Steve “Prez” Kliemisch - Feb 5
Wendy “Popcorn” Capotosto - Feb 9 Mark Heinbockel - Feb 13
Linda “Tink” Avveduti - Feb 29
Armando & Nancy Matos - Feb 16
TREASURE COAST CHAPTER
FEBRUARY 21
HIGHLIGHTED ITEMS INDICATE A TREASURE COAST EVENT
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
FEBRUARY
1
Memorial Ride
2 ABATE breakfast
Groundhog Day
3 4 5 6 7 8
State Meeting
9
Valentine
Service
10
11 12
13 14
Valentine’s
Day
15
16 17
President’s
Day
18 19
Board
meeting
20 21
Bike night
22
23
Biker Church
Fiasco Bro.
Anniversary
24 25 26
General
meeting
27 28
ALSO LOOK FOR OTHER EVENTS THROUGHOUT THE NEWSLETTER
MARCH
1
Grant
Seafood
Festival
2 ABATE Breakfast
Grant Seafood Festival
3 4 5 6 7
Daytona
Bike Week
starts
8
9 10 11 12
13
14
Boondocks
Poker Run
15
16
Daytona
Bike week
ends
17 18
19 Board
meeting
20
21
Bike night
22
23
Biker
Church
HALO
Run 30
24 25 26 General
meeting
27 28 29
Fellsmere
Every 4th
Sunday
9:15 am … Free Cont Breakfast
10:00 am … The Word
ALL are Welcome… ride or not
Hosted by: TestiFire Ministries Shep Kim (772) 913-5549
Location: 12420 County Rd 507 (Babcock St)
¼ mile south of C54 Bridge, Fellsmere
Look for CMA Tent & Biker Church Signs
MEMBERSHIP Val Loper PO Box 220346 Hollywood, FL 33022-0346 (954) 918-1287 (954) 926-5665 (Fax) [email protected]
MASTERLINK EDITOR C/O State Office PO Box 2520 DeLand, FL 32721-2520 (386) 943-9610 Fax: (386) 943-9610 [email protected]
LEGAL COUNSEL Larry Crow 1247 S. Pinellas Ave. Tarpon Springs, FL 34689-3719 (727) 945-1112 Fax: (727) 945-9224 [email protected]
LEGISLATIVE Darrin “Scribe” Brooks PO Box 2520 DeLand, FL 32721-2520 (239) 398-7145 (386) 943-9610 (Fax) [email protected]
PRODUCTS Steve “Caretaker” Knee PO Box 4372 Milton, FL 32572-4372 (850) 529-4446 (386) 943-9610 (Fax) [email protected]
DIRECTOR 0F SAFETY EDUCATION Charlie Wenger PO BOX 2520 DeLand, FL 32721-2520 (954) 650-1420 (561) 333-6773 (Fax) [email protected]
Bylaw Review Committee [email protected]
LEGISLATIVE HOT LINE 1-866-FLABATE (1-866-352-2283) Toll Free Inside Florida Only
WEB PROBLEMS Dan “Slo Mo” Henderson [email protected]
2012-2014 BOARD OF DIRECTORS
STATE OFFICE ABATE of Florida, Inc. PO Box 2520 DeLand, FL 32721-2520 (386) 943-9610 (Fax Same) [email protected]
PRESIDENT Danny “ Doc” Fish PO Box 3615 Milton, FL 32572-3615 (850) 994-3652 (850) 995-8517 (Fax) [email protected]
VICE PRESIDENT Emory Griffis PO Box 2520 DeLand, FL 32721-2520 (386) 801-3327 (386) 943-9610 (Fax) [email protected]
SECRETARY Bob Alexander PO Box 2520 DeLand, FL 32721-2520 863-202-0905 [email protected]
TREASURER Patti Nasrallah PO Box 16309 Temple Terrace, FL 33687-6309 (813) 695-9203 Fax: (813) 626-2306 [email protected]
SGT. AT ARMS Dennis “Mudder” Rudoi PO Box 2520 DeLand, FL 32721-2520 (407) 925-4307 Fax: (407) 699-9748 [email protected]
PR/COMMUNICATIONS Rhonda Griffis PO Box 2520 DeLand, 32721-2520 (407) 412-8381 (386) 943-9610 (fax) [email protected]
Office of Governor Rick Scott State of Florida
The Capitol 400 S. Monroe St.
Tallahassee, FL 32399-0001
Lt Governor Jennifer Carroll State of Florida
The Capitol 400 S. Monroe St.
Tallahassee, FL 32399-0001 Citizen Services Hotline: (850) 488-4441
Executive Office of the Governor Switchboard: (850) 488-7146 [Office hours are 8:00 a.m. to 5:00 p.m. Eastern Time]
Fax: (850) 487-0801
Senator Mike Haridopolos
District 26 -- Republican District Office:
3270 Suntree Boulevard, Suite 122
Melbourne, FL 32940
(321) 752-3131 Tallahassee Office:
322 Senate Office Building 404 South Monroe Street Tallahassee, FL 32399-1100 (850) 487-5056 Senator Joe Negron District 28 -- Republican District Offices:
3500 SW Corporate Parkway Suite 204 Palm City, FL 34990 (772) 219-1665, FAX (772) 219-1666 [email protected] Tallahassee Office:
306 Senate Office Building
404 South Monroe Street Tallahassee, FL 32399-1100
(850) 487-5088
US CONGRESSMAN BILL POSEY Washington DC Office District Office
132 Cannon HOB 2725 Judge Fran Jamieson Way Washington, DC 20006 Building C
Phone: (202)225-3671, Fax: (202)225-3516 Melbourne, FL 32940
Phone: (321)632-1776, Fax: (321)639-8595
Indian River County: Phone: (772)778-3534 Toll Free: 1-888-681-1776
REP DEBBIE MAYFIELD District 80 -- Republican Capitol Office:
REP TOM GOODSON District 29----Republican Capitol Office:
REP JOHN TOBIA District 31--Republican Capitol Office:
317 House Office Building 222 The Capitol 209 House Office Building 402 South Monroe Street 402 South Monroe Street 402 South Monroe Street Tallahassee, FL 32399-1300 Tallahassee, FL 32399-1300 Tallahassee, FL 32399-1300 Phone: (850)488-0952 (850) 488-3006 Phone; (850)488-2528 District Office: District Office: District Office:
1053 20th Place Suite 1C, 400 South Street Suite 508 Vero Beach, FL 32960 Titusville, FL 32780-7610 1901 South Harbor City Boulevard Phone: (772)778-5077 Phone: (321)383-5151 Melbourne, FL 32901-4770
Phone: (321)984-4848
ABATE of Florida, Inc.
Treasure Coast Chapter
P. O. Box 1360 Roseland, FL 32957-1360
Date: _________________
Name (please print legibly): _____________________________________________ Membership Number _________
Mailing Address: ___________________________________________ ______________ _
City: ________________________________________ State:_____________________Zip Code: _______-_______
Phone Number (include Area Code): ________________________________
Are you a registered voter? Yes N o
Please list your voting districts from your Voter Registration Card:
________________ FL House ____________ FL Senate _____________ US Congress
E-Mail Address: ___________________________________________________________ for weekly updates
IF YOU WISH TO RECEIVE THE NEWSLETTER BY MAIL (not email) ONLY, PLEASE
CHECK HERE_______________
IF YOU WISH TO RECEIVE THE NEWSLETTER BY EMAIL (not mail) ONLY, PLEASE CHECK HERE_______________ EMAIL: ___________________________________________
If member of more than one Chapter, please declare your home Chapter
- Check the box that applies to you:
New Annual Membership ($20) Life Membership ($150) Transfer Membership from __________________Chapter (attach a copy of membership card) Change of Address
Renewal Prime Member ($20)
All members receive with their paid membership a membership card, our monthly newsletter, the State ABATE bi-monthly Masterlink magazine, Chapter voting privileges, and personal involvement in statewide legislative actions and their freedom to ride! SIGNATURE
ABATE Office Use Only
D ue s pa id by: Cash Check # ______ Money Order Amount $________________
▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬
CHANGE OF INFORMATION FORM
OLD INFORMATION: NEW INFORMATION:
Name Name
Address
Address
City St Zip City St Zip
Phone: Email Phone: Email
SIGNATURE: _________________________________ DATE: _________________________