Opt-In Consent Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

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Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

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Date

We are excited that you are interested in participating in Delta 4 Women in Action, empowering women as an independent 501(c)(4), Delta-affiliated, nonprofit social welfare and advocacy organization. The mission of the organization centers around four pillars: advocacy, training, lobbying, and networking. These pillars serve as the organization’s guide as we build stronger communities.

To ensure your full understanding and consent regarding your participation, please read the following statement:

Consent for Participation:

I willingly and voluntarily consent to participate in Delta 4 Women in Action. I understand this consent authorizes direct communication from the organization and engagement of activities, initiatives, and efforts. Also, I confirm that my participation is entirely voluntary.

Use of Information:
I acknowledge that any information, including but not limited to photographs, videos, testimonials, and feedback collected during my participation in Delta 4 Women in Action, may be used by the organization for promotional and educational purposes. This may include, but is not limited to, social media, websites, printed materials, presentations, phone and text banking fundraisers, and any other related usage.

Data Protection:
I understand that my personal information will be treated confidentially and will not be shared with third parties without my explicit consent, except as required by law.

Opt-In Consent:

By signing below, I confirm that I am providing my explicit opt-in consent for using the information outlined in this statement. I can terminate my consent anytime with notification to Delta For Women in Action, Inc.

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