First Name
Last Name
Address
City
State
Zip
Phone (home)
Fax
e-mail
Phone (office)
Occupation
Organization
Spouse Name
e-mail
Phone
(office)
Occupation
organization
Child 1
Sex
Year born
Child 2
Sex
Year born
Status
(c for citizen, p for permanent
resident)
Membership
(i=individual, f=family,
s=student)