The Citizens Commission for the

Safety & Care of the Elderly Reports

ELDER COMMISSION

Information Update Form

If you need to update your information and it has not been submitted to the

Citizens Commission for the Safety and Care of the Elderly

please download this form, print it and mail or email it to:

Chief Richard Susi, ret, at
rifirechiefs@gmail.com

or
PO Box 6041
Providence, RI 02940

 

Advocate Contact Information:

PUBLIC MEMBER or APPOINTED MEMBER

Department : __________________________________________

Advocate Name: _____________________________________________________

Address: __________________________________________________________

City: ____________________________ State: _______________ Zip Code:_____________

Email address: __________________________________

Business phone: _________________________________

Cell phone: _____________________________________

Other phone: ____________________________________