Update your CPOF Membership Use this form to update your CPOF membership! What type of membership do you have?(Required) Payroll Deduction LumpSum Bank Draft Monthly Subscription What changes would you like to make?(Required) Update Name, Address, or contact information Update Membership Type Update Facility Update Person of Choice Update Donation Amount Multiple Changes Name(Required) First Middle Initial Last Date of Birth(Required) MM slash DD slash YYYY Date of Hire(Required) MM slash DD slash YYYY Please provide the best contact information to reach out to update your membership type.Update Your Name First Middle Initial Last Please use this to update your legal nameAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Institution (Place of Employment)Institution State(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingJob TitleEmployee ID#Social Security Number:Cell PhoneEmail Spouse (Person of Choice)Monthly DonationDonation Amount$5.00$10.00$15.00$20.00$25.00$35.00$50.00Your monthly donation is split based on your pay schedule. After 6 months of active membership, those contributing $25 a month or more will receive a special membership gift. SignatureSignature(Required)Date(Required) MM slash DD slash YYYY Δ