Privacy Provisions Form

The Canary & Cage Bird Federation of Australia Inc

PRIVACY PROVISIONS CONSENT FORM

SEND TO:

Ron Robertson

Hon Secretary/ Treasurer

The Canary & Cage Bird Federation of Australia Inc

PO Box 230

Frenchs Forest

NSW 1640

I

Name in BLOCK LETTERS

of

Name of Club

being __________________________________________________________________

Office bearer position

hereby consent/ do not consent [delete one] to the inclusion of my personal contact details listed below in the *Feathered World publication and on the *Federation’s web site. [*Delete if not applicable]

Please list only current contact details for inclusion.

YOUR NAME:

MEETING DETAILS:

CONTACT NUMBERS

Phone:

Fax:

Email:

Signature: Date: