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Author Distributions Program Change of Address Form


Your ACA Contact Information:
If you are a recipient of funds from ACA's Author Distributions program and wish to change your contact information with ACA, please complete the following fields.


Note: All the below fields marked with the symbol * are mandatory.
 
* First Name
* Last Name
Company or Organization Name
* Address 1
Address 2
* City, State or Province,
ZIP or Postal Code

* Country
* E-mail
Phone

Contact Information You Have Authorized ACA To Provide To Third Parties:
If you have authorized ACA to give contact information to third parties that differs from your ACA contact information, and that information has changed, please complete the following fields, as applicable to the information you wish to disclose.

First Name
Last Name
Company or Organization Name
Address 1
Address 2
City, State or Province,
ZIP or Postal Code

Country
E-mail
Phone

Please send us any questions or comments.
* Type the Code Shown below
 

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