Membership Directory

This form is used to create or update the ELC Membership Directory.
  • Date Format: MM slash DD slash YYYY
    By default, this entry is marked NO indicating that this is your first submission. If you have PREVIOUSLY submitted this information, please change this response to YES.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Dependent's First NameDependent's LastnameGender of DependentYour Relationship To DependentDependent's Date of BirthHas this Dependent been Confirmed (Y/N) 
    If you have more than one dependent, Click on the plus (+) sign at right edge of entry to make additional entries
  • Enter any other information that you think we should be know.
  • This is to ensure that you are a real person.