Contact Information Authorization

In accordance with our Privacy Policy, certain contact information for MVS members is not shown on this website unless specifically authorized by the member. Information that will not be shown includes your USAS registration number, street address, zip code and all telephone numbers.

If you prefer not to have this information shown, you need not do anything - it will be hidden from view automatically. However if you prefer to have all of your contact information shown, complete this form to authorize its display. Likewise, if you have previously authorized the display of your contact information and you now wish to withdraw it, complete this form to rescind your previous authorization.

Your USAS registration number will never be shown even if you authorize the display of all other 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 websites, or otherwise, of 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 Telephone
	Street Address		Work Telephone
	City and State		Fax Telephone
	Zip Code		Email Address

	Always shown regardless of authorization.

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 #:
		Display Contact Information:	Authorized
			Not Authorized
		Email Address: