Texas-Oklahoma District
Club Officer/District Chair
Internet Permission
The Texas-Oklahoma District of Kiwanis International Web site does not use personal information including photos without permission. This information may be available to anyone having Internet access. The following is a permission agreement allowing the Texas-Oklahoma website to post the following information about:
Name: _______________________________ Administrative Year : 200__ -- 200__
Position held: ¨ T-O District Officer _____________________________
¨ T-O District Chair _____________________________
¨ Lt. Gov. Division _____________________________
¨ PLGA Officers _____________________________
Permission is granted to use the following: [Please mark Yes or No and list number
Photo: ¨ YES ¨ NO Mailing Address ¨ YES ¨ NO
Home phone: ¨ YES ¨ NO __________________________
Work phone ¨ YES ¨ NO __________________________
Cell phone: ¨ YES ¨ NO __________________________
Email address: ¨ YES ¨ NO __________________________
Other: ¨ YES ¨ NO _____________________________
______________________________ ______________________________
Signature Date
NOTE: If pictured with another person, then this applies to that person also.
Return to:
Jimmy Brown
Texas-Oklahoma Webmaster
11988 FM 822 Edna, TX 77957
If you have questions, call Jimmy Brown at 361-782-3362