Change in Status Form

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NALS Membership #

Reason for Change:

Preferred Address
Address Correction
Name Change
Transfer Membership
Deceased

Old Information: Business Home

Name
Address
City
State Zip
Primary Chapter
Member-at-Large
Associate Member
Email Address

New Information: Business Home

Name
Address
City
State Zip
Primary Chapter
Member-at-Large
Associate Member
Email Address

Current Phone Numbers:

Home
Business
Fax

Instructions for Transfer: If you are transferring to a new association, submit one photocopy to the membership chairman of the chapter to which you are transferring; if you are a member-at-large, submit one photocopy to the state membership chairman of the association to which you are transferring. Instructions for Completion: Submit this online form or mail an original printed form to the NALS Resource Center, 314 East Third Street, Suite 210, Tulsa, OK 74120. Return one photocopy (print this form from your web browser before submission or use the printable version) to the State Membership Chairman. Return one photocopy for the Chapter records or retain for your records if you are a member-at-large.