Participant Info

Membership Number
560
Salutation
Mr
First Name
Dale
Middle/Maiden/Previous
Last Name
Ellis
Address 1
PO Box 457
Address 2
City
Ketchum
Zip Code
74349
Phone
918-557-5415
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