The undersigned hereby consents to the collection and use of the following information by Missouri Valley Swimming, Inc. and USA Swimming, Inc. in connection with the athlete committee and athlete representatives. This authorization shall continue in effect until revoked by me in writing delivered to the MVS Board or the Member Services Department of USA Swimming, Inc.
This authorization covers the following information:
Home or Cellular Telephone Number
Personal or Family E-mail Address.
If you would prefer that a particular piece of information NOT be published, please indicate that below (No = not published).