Permission Form

Web permission form to publish contact information online.

Instructions

Fill in all the information below.
Check the boxes of the information you want to be displayed.
An SCA name and one piece of contact information is the minimum required.
If only one piece of contact info is provided, the e-mail address is recommended.
An e-mail address is required if you wish to submit the form electronically.

To submit:

Physically print, sign, then mail this form to the address below
OR
Fill in the information below and press the submit button.
- You will be sent an e-mail at the address you list
- You must complete the last section and reply to this e-mail.
- You will then receive a confirmation email; the process is then complete.

Permission to publish contact information online release form.

I do hereby grant permission for my contact information detailed below to be listed on a recognised SCA Website.

Modern Name:	Publish
SCA Name:	Publish
E-mail:	Publish
Address: City, State Zip:	, Publish
Phone Number:	Publish	Call times (optional):Publish
Office:
Personal OP:	Publish
	If a picture exist on file, I give permission for my likeness to be used on the website.

This permission shall be considered to be in effect until written notification is received requesting removal of any such information. If the listing of contact info is required for the position I hold, requesting my listing be removed may make me ineligible to continue holding this office.

I recognize that persons unknown to me may link to this site or may use my information without my permission. I shall hold the SCA Inc., the Kingdom of Calontir, local groups, the web minister and the domain name owner harmless from such activity.

Signed ______________________________________________ Date _________

Electronic Signature

For Snail-mail: Send form to Paul Fry, 317 Jackson St., Warrensburg, MO., 64093