Member Information Update - 12/24
In an effort to update NEB Membership Roster your information is needed below.  Thanks.
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Last Name *
First Name *
Street Address *
City *
State *
Zip Code *
Email *
Telephone (format: xxx-xxx-xxxx) *
Gender *
Birthdate (format: 00/00/0000) *
Spouse's Name
Children's Name(s) & Ages
Emergency Contact Name *
Emergency Contact Number (xxx-xxx-xxxx) *
Submit
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