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Contact Authorization Form
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Note: This form is for adding District-level positions (including Area Governors) to the District website. It is NOT for adding Club Officer Contact information to it. Club Contacts can be added to the WHQ website at www.toastmasters.org.

World Headquarters requires that we have written authorization before we publish any personal information on the District website. Therefore, we ask that you fill in this form to expedite us getting that written authorization. After we get the form, we will probably call or email you to verify that it was you who actually submitted the form. Thanks for understanding.

* Indicates required information

Information About You
Note: Do not submit this form for anyone else!
Section 1 - Basic Information
* Your Name:
* Designation:
(None, CTM, ATM-B, CL, etc.)

* Reason:

Check as many as are applicable at this time.

Put details in the text box below.

Division Gov (please specify which division below)
Area Governor (please specify which area below)
Contest contact (please specify which area or division contest below)
Supplemental Training contact (please specify which division 's training below)
Other District Officer or staff (please specify which position below)
Other reason (please specify the details below)

* Details:

 


 

Section 2
This section is so we can contact you about questions we have regarding this form. We will NOT put this section on the Internet.

* Email:
Home
Work
* Phone:
Home
Work
Cell

 

Section 3
This section is what we WILL put on the Internet. Although we take specific efforts to try to keep "spam bots" from harvesting these email addresses, please be aware that there is a reasonably high probability that you will receive spam once you place your email address on any webpage.

By filling in the information below, you are authorizing us to place that information on any page on the District 27 website.

Please fill in as much or as little information as you wish to be published.

I have read the statement in the above box and understand it and have filled out the the following Email and Phone fields accordingly.
 Yes No
Email 1:
Home
Work
Neither
Email 2:
Home
Work
Neither
Phone 1:
Home
Work
Cell
Neither
Phone 2:
Home
Work
Cell
Neither

 

Section 4
This section is normally not needed. Only fill it in if you have specific reasons for wanting an address or fax # publicised on the District 27 website.

Address:
City, State Zip:
Fax:
* Reason:
(required if this section is filled out)

 

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