Employees Activities Association
Change of information request form:

        Please check one of the following and complete the form below:

I am in an EAA sponsored insurance program, fitness center or wireless phone service program and need to change my address.

I am in an EAA sponsored insurance program, fitness center or wireless phone service program and need to change my name.

    I am in an EAA sponsored insurance program and need to change my beneficiary/beneficiaries. (Please complete and submit the following to have a change form mailed to you.)

     I would like to be on the EAA mailing list. Note: You must be an EAA member to be added to EAA mailing list.

        Please provide the following contact information: 

Name
Change To(name)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
FAX
EAA Card No.

Any comments or suggestions are welcomed: