CHANGE OF MEMBER INFORMATION-CGAUX-33
A.
GENERAL-This form is used to enter permanent changes to a member's
personal information on record with the U.S. Coast Guard Auxiliary.
B.
PRESENT MEMBER INFORMATION-This line must always be completed. Enter
your present Auxiliary member number and name exactly as it appears in
the Quarterly Roster or Annual Member Summary and Status Report.
C.
ONLY FILL IN THE INFORMATION REQUIRING CHANGES IN THE FOLLOWING
BLOCKS. If the information is not to be changed, leave the block or box
blank; If information is to be deleted, write "delete" in the appropriate
box.
1. LAST NAME-If JR., SR. or Numerals are used, include them in this
block.
2. FIRST NAME AND MIDDLE INITIAL-Enter normal as written,(Jo Ann M.,
Macann R., etc.).
3. SPOUSE'S NAME-Use spouse's given name, no nicknames. If not
applicable, enter N/A.
4. STREET-Enter new street or P.O. Box address.
5. CITY-Enter new city where street or P.O. Box is located. Enter the
country after city if the residence is outside the United States.
6. STATE-Enter new official two-letter postal designation. If residence
is outside the United States-leave blank.
7. ZIP-Enter new five number ZIP code, plus ZIP+4, if known (63128-1903).
8. TELECOMMUNICATIONS-Enter any new telephone numbers and E-mail
addresses or "delete" to remove.
9. MAIL LIST-Check the appropriate box to change whether to Add/Delete
mail from the indicated Auxiliary level.
10. EMERGENCY CONTACT-Enter new name, address, telephone number with Area
Code and relationship of person to be contacted.
11. OCCUPATION OR STATUS-Enter new occupation or status.
12. SIGNATURE AND DATE-Signature as normally written and date.
13. REPORT NUMBER-Consecutively number for your reference.(001,002, etc.)
PRIVACY ACT STATEMENT
In accordance with 5 USC 552a(e)(3), the following information is
provided to you when supplying personal information to the United States
Coast Guard.
1.
AUTHORITY which authorized the solicitation of the information:
14 USC
Sec 823
PRINCIPAL PURPOSE(S) FOR WHICH INFORMATION IS INTENDED TO BE USED: To
2.
establish eligibility for enrollment and a record for the individual in
the Auxiliary Information Management System.
3.
THE ROUTINE USES which may be made of the information: Provide
identification, address and personal information to the following:
(1)Directors of Auxiliary. (2)Members of the Auxiliary.
4.
WHETHER OR NOT DISCLOSURE of such information is mandatory or voluntary
(required by law or optional) and the effects on the individual, if any,
of not providing all or any part of the requested information: Disclosure
of this information is voluntary, but failure to provide information will
prevent enrollment of the person in the Auxiliary.
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