EmailMeForm
Consent to Disclose Contact Information
on Steeplechase website
1. I understand my information on the Steeplechase website can only be accessed with a username and password.
2. I understand this form can be used to refuse having my information posted.
3. I understand this form can be used to rescind my consent.
4. I understand that a record of this consent will be kept on record and a copy made available on request.
The following information can be posted on the Steeplechase website:
Owner Name(s):
*
Address:
*
Unit #:
*
Home Phone
*
###
-
###
-
####
Cell Phone
###
-
###
-
####
Email
*
Email
Select one :
*
I DO authorize to disclose on the community website
I DO NOT authorize to disclose on the community website
