Personal Info
| Church/Organization | |
| Preferred First Name | |
| Street Address | Po Box 205 |
| City | Marysville |
| Postal/Zip Code | 98270 |
| Mobile Phone | |
| Website | |
| Home Phone | |
| Office Phone |
General Membership Info
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Widow |