WAMEDA permission form

Please send this completed form to

WAMEDA
C/O DANCER
8010 OLD BRANCH AVE
CLINTON MD 20735

I give permission to publish my phone number, email address, and web site address.
Phone:
Email:
Web site:
I give permission to publish my address.
Address:
 
State:
Zip:
I give permission to publish my photo (at a cost of $10 per photo). Please note that group photographs should have each group member's signature attached.
Signature(s):
 
 
Name:
Signature:
Date:

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