Send to:
Phil Thomas
141 Howley Ave.
Beaver Falls PA 15010

I (WE) the undersigned do agree to have MY (OUR) information from the
membership directory of Beaver County Kennel Club (BCKC) added to the
Breeder Referral portion of the BCKC and or SVC Websites.

I (WE) understand that publishing such information on an internet website
makes that information open to public scrutiny and I (WE) agree to hold
Beaver County Kennel Club blameless for any and all problems that may
arise due to the publication of information.


I (WE) understand that requests for removal from this Website must be       
made In WRITING and addressed to Phil Thomas, Webmaster.


All website information will be removed upon termination of membership.

Name(s)_______________________________________________________

Signature(s)__________________________________________________

(All new Parties to be listed on the website MUST SIGN
E-mail Waivers will NOT be accepted)

Date____________
WEBSITE BREEDER REFERRAL RELEASE FORM

If you would like to
have your name and
contact information
included on our BCKC
Website Breeder
Referral and theSVC website you must be a
member in good
standing of BCKC. You
are REQUIRED to
complete and sign this
information release
form and return it to
Phil Thomas

Your name will not be
included without a
signed release on file.
You can print this
release and mail it to
Phil at the address       listed on the right.


PLEASE CIRCLE THE DIRECTORY IN WHICH YOU PREFER TO HAVE YOUR
INFORMATION PUBLISHED ON THEIR WEB SITE.
Circle both if you wish to be included in both directories.


    BCKC     SVC

Website Information Release Waiver