Participant Info

Membership Number
2016
Salutation
Ms
First Name
Regina Shasteen
Middle/Maiden/Previous
Last Name
Grisham
Address 1
4740 Plainview Road
Address 2
City
Oakwood
Zip Code
30566
Phone
678-314-1021
Work Code #
Date of Birth
Date of Death
Deceased At Join?
Comments
Name/Location of Company Worked
Dates of Work
Type of Work
Rosie Name if Rb or Rv
Is/Was Rosie a member of ARRA?
Contact Name (Deceased Rosie Contact)
Contact Email Address
Contact Phone Number