Participant Info

Membership Number
3597
Salutation
First Name
Derek
Middle/Maiden/Previous
Last Name
Blough
Address 1
318 Elm Apt 2
Address 2
City
Findlay
Zip Code
45840
Phone
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