Contact Information Authorization

Instructions

In accordance with our Privacy Policy, contact information for MVS members is not shown on this website unless specifically authorized by the member. Information that is not shown by default includes the member's street address, city, state, zip code, telephone numbers, and email address.

If you do not wish to have the above information shown, you need not do anything - it will be hidden automatically.
However if you prefer that some or all of your contact information is shown, complete this form to authorize its display.
If you previously authorized the display of some or all of your contact information and you now wish to withdraw it, complete this form to rescind your previous authorization.
Your USAS registration number is never shown even if you authorize some or all contact information.
To verify your identity, you MUST enter your USAS registration number exactly as it's on file with the MVS office.


By providing my full name and USAS registration number below, I hereby authorize (or no longer authorize) the publication on this website, or otherwise, the following types of personal contact information I have provided to Missouri Valley Swimming, Inc. and/or United States Swimming, Inc. in connection with the administration of their activities and my involvement therewith:

	Full Name		Home Phone
	Street Address		Work Phone
	City, State & Zip		Fax Phone
	Club Affiliation		Mobile Phone
	Official's Certification		Email Address
	Coach's Position		Registration Year
	Always shown regardless of authorization status.

To the greatest extent allowed by law, I agree to hold Missouri Valley Swimming, Inc. and USA Swimming, Inc. harmless from and against any and all claims arising from the publication of the information authorized above. This authorization shall remain in force until such time as I expressly withdraw it by notice to Missouri Valley Swimming, Inc.

		Last Name:
		First Name:
		Team or Club:
		USAS Reg #:

		Contact information authorized to be shown on this website: (check all that apply)	Address & City:	Authorized Not Authorized
			Home Phone:	Authorized Not Authorized
			Work Phone:	Authorized Not Authorized
			Mobile Phone:	Authorized Not Authorized
			Fax Phone:	Authorized Not Authorized
			Email Address:	Authorized Not Authorized

		Email Address: