US JCI Senate - Change of Address

This form allows US JCI Senate members to submit an address change.  Note: All information fields are required (*)

Name (*)
Please let us know your name.
Senate # (*)
Please include your Senate Number
Address (*)
Invalid Input
City (*)
Please enter your City
State (*)
Please enter the State
Zip Code (*)
Please enter your Zip Code
Your Email (*)
Please let us know your email address.
Preferred Phone Number (*)
Please enter your preferred phone #
State Memberships (list all) (*)
Enter your state membership
Are you a state office or serving in a US JCI Senate postion? (*)
Are you an officer?

This information will be forwarded to the Membership Information Services Program Manager.  Your information will be used to update our membership roster plus your mailing address for Mentors Magazine.  A copy will also be forwarded to your state treasurer and the US JCI Senate Secretary.