Participant Info

Membership Number
111
Salutation
Mrs
First Name
Patricia
Middle/Maiden/Previous
Tetlus
Last Name
Derecas
Address 1
1400 First Avenue West Apt 405
Address 2
City
Bradenton
Zip Code
34205
Phone
212-243-9036
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