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.
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)
- If you are a registered leader - which District and Unit are you registered in? _________________ __________________
- Position, activity, or reason for listing name and contact info _________________________
- Name (as registered) _______________________________
- Phone (home) ___________________
- Phone (cell) ___________________
- Phone (work) ___________________
- Email (home) __________________________
- Email (work) __________________________
- Mailing address: (Not recommended - use only when it is necessary to mail registrations, etc to this person)
- __________________________ This is my ___home or ___work address.
- __________________________
- __________________________
-
Signature ____________________________________ Date ___________
Last Updated Thursday, 03-Dec-2009 11:31:50 MST