Division 14 Web Site Information Authorization Form

Division 14 will no longer display member information unless this authorization form is completed and submitted to the Division 14 webmaster. You may use the form below, which is emailed automatically to the web master when the form is completed properly or you may mail or fax the information to Jimmy R. Hammond at 214-B Eastern Ave., Annapolis, Maryland 21403 or fax it to 410-267-8668.

The completion of the form below and transmission to the Division 14 Web master in any manner described above, represents your authorization for each field if completed, to be placed on the Division 14 web site, for access by Kiwanians and visitors to the web site, until such time that you would revoke your authorization in writing.

For additional information or guidance contact Jimmy R. Hammond at 410-267-8686 or by email at Jimmy@capitalconsultant.net

All fields must have an entry! Enter "NO" in any data field if not available for publication!

Kiwanis Affiliation: 
Member Name:
Member Telephone Number:
Member Fax Number:
Member Cell Number:
Member Email:
Member Address: Street, City and Zip Code


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This page provided by Capital District-Division 14 and funded by the Kiwanis Club of the Severn, Annapolis MD
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