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AWDA logo, with letters A (large, italic, upper case, in white that merges into white page background, with ared shadow, over green circle), w (lower case in green with shadow over a large, green circle with Artists with Disabilities Alliance in white italic text at circle top), d (in white lower case, with shadow, over wwwhite triangle, and a (blue lower case in blue with shadowover blue rectangle)

AWDA Permission to Publish
Private E-mail Information Form
(Please list info when possible! Thanks!)

This form is intended for use only by the Artists With Disabilities Alliance -- for communicating to and networking among members.
There is no charge at this time for membership; all current activities are volunteered by members.

Completing this permission is a waiver of privacy rights and is completely voluntary.
E-mail information will not be given out unless you agree to this by completing this form.

      

First name?

       Last Name:

    Telephone no if any:    Fax no if any:

      What is your e-mail address-required?

Preferred means of contact about AWDA meetings/activities - indicate (check one)

e-mail:   mail:   phone:   fax:


_________________________________________

Do you give your permission for your e-mail address to be sent to other AWDA members?

YES NO



Paella write in other qualifications or limits to this permission to give out your e-mail address, if given:


By submitting this form I waive all rights and claims, inclusive but not limited to, data privacy, or consequential misuse of
information by any party, under state of federal law, against: AWDA, VSA Arts, OpusArts LLC,, and all past, current or future affiliates of AWDA.

 
Webmaster: MariJayn at OpusArts LLC. E-mail Webmaster