Participant Info

Membership Number
4019
Salutation
First Name
John H
Middle/Maiden/Previous
Last Name
Wayne II
Address 1
9551 W Carol Ave
Address 2
City
Peoria
Zip Code
85345
Phone
607-292-0957
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