Participant Info

Membership Number
4685
Salutation
Mr
First Name
Dan
Middle/Maiden/Previous
Last Name
Watt
Address 1
2636 Hogan Ave
Address 2
City
LaPorte
Zip Code
46350
Phone
219-877-4018
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