Change of Address

If you are having a change of address, please complete the following so we can update our files:

Member no
Old data
Name
Address
Post code
City/State
Country
E-mail
New data (you can put in only the fields which will change)
Name
Address
Post code
City/State
Country
E-mail

I want this change to be effective from the following date:
 (DD-MM-YYYY)

Comments and/or questions: