Comox Valley Unitarian Fellowship Permission Form for publishing information on the Fellowship List Personnel Information Protection Act (PIPA) Date: MM slash DD slash YYYY Name: First Last Partners Name: First Last Children's Names and Birthdays:NameBirthday May we list the names on the Fellowship list? Yes No Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Mailing Address:If different from your home address. Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code May we list the address(es) on the Fellowship list? Yes No Phone number/s Emaill/s May we list this phone number and email on the Fellowship list? Yes No Would you like PAD information?PAD = preauthorized donation forms Yes No CaptchaNumberUntitled Δ
