Participant Info

Membership Number
4015
Salutation
First Name
Roberto T
Middle/Maiden/Previous
Last Name
Ortega
Address 1
PO Box 665
Address 2
City
Portales
Zip Code
88130
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