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Member Status Change Form
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First name
*
Last name
*
Employer
*
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AT&T
Avaya
CBRE
Stark Metropolitan Housing Authority
Thryv (formerly DEX/YP)
University of Akron
Date Change Effective
*
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Month
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May
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Day
Day
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Year
Year
2020
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Reason (Ex. retirement, resignation, layoff, transfer, etc.)
*
Name of Submitter (Leave Blank if Same as Above)
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