Permission To Publish Your Name and Contact Information on Longs Peak Council and District Web Sites

This form should be used by persons who need to be listed on the Longs Peak Council Web Site or on any of the District Web Sites of the Council. For example -- the organizer of an event or activity, district committee positions, training contacts, etc.

Print this form, complete it, and return it to the Council Webmaster (to request the mailing address or FAX #, please send an email to webmaster@longspeakbsa.org).

(Please print clearly)

I am 18 years old or older.

If the web information is related to Venturing, I am at least 21 years old.

If you are a registered leader - which District and Unit are you registered in? _________________ __________________

Position, activity, or reasons for listing name and contact info _________________________

I grant permission to publish my name, and the following phone numbers, email address, and/or mailing address on the Longs Peak Council and District Web Sites (list only those you want published):

Name (as registered) _______________________________
 
Phone (home) ___________________
 
Phone (cell) ___________________
 
Phone (work) ___________________
 
Email __________________________
 
Mailing address: (Not recommended - use only when it is necessary to mail registrations, etc to this person)
 
    __________________________
 
    __________________________
 
    __________________________

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Signature ____________________________________ Date ___________

Last Updated Sunday, 04-Feb-2007 16:00:31 MST