Name (please print):  ______________________________________________

 

SSN:  _______________________________________________________

 

Transfer my membership from District # _____  (if known) to District #  25

 

 

_____________________________________    _______________________

Signature                                                                Date

 

 

If you prefer not to supply your SSN, you may contact:

 

SEANC’s Central Office in Raleigh:

 

Local Phone: (919) 833-6436

Toll-free Phone: 800-222-2758

Regular office hours are Monday-Friday from 8 a.m.-5 p.m.