Change of Address Form

 Retiree Name: 

 Spouse Name:

      Former Address

Address 1:

  City:

 State: Zip Code:

New Address

Street:       

Address 2: 

 City:  

 State:  Zip Code:

 Phone #: 

 Area Code: 

e-mail:

 This form can be printed and mailed to:

           XRX Pioneer Club of Rochester, Inc.
(P.O. Box to be determined )
           Webster, NY  14580

OR

The information can be sent via email by clicking on the Submit button below.

(PLEASE DO NOT CALL IN CHANGES)