Band Member New Contact Information Form

Please keep your information up to date so we are able to contact you with Band News.

If you have any questions about using this form, please contact Colleen Yorke

First Name Last Name

Preferred Email

Other Email:

Enter Phone Numbers as: area code-xxx-xxxx

Home Phone:

Cell Phone:

Instrument/s Played	Bagpipes
	Snare Drum
	Tenor Drum
	Bass Drum

Work Phone:

Home Address

City

State

Abbreviate (NJ)

I currently play with the following competition band:

Competition Grades Grade III Grade IV Grade V

Select only if applicable

Zip

Birthday

Notes

By clicking the “Submit My Information” button,
you are providing Saint Columcille United Gaelic Inc.
(hereafter Saint Columcille UG) with permission to post on its web page your personally
identifiable information (PII) that you provided.

In addition, while Saint Columcille UG seeks to utilize web providers with security considerations
to host its website and while Saint Columcille UG plans to use your PII on a pass code-based
page for members only, you also agree that, by clicking on the “Submit” button, you will
not hold Saint Columcille UG liable in the event that your PII is inadvertently disclosed publicly.