We are working on creating a Membership Directory for the DWC of Lee County.

In order to do this, we need permission from each member for the following:

• Whether or not you want to be included in the directory
• Specific permission for each item of information to include about you

Please note: A member will not be included in the directory unless permission is given through this form.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Do you want to be included in the Directory (minimum FIRST and LAST name)? *Yes, include me in the directoryNo, do NOT include me in the directory

If you chose "YES" to be included in the directory, do you want your MAILING ADDRESS in the directory? *Yes, include my mailing address in the directoryNo, do NOT include my mailing address in the directory

If you chose "YES" to be included in the directory, do you want your EMAIL ADDRESS in the directory? *Yes, include my email address in the directoryNo, do NOT include my email address in the directory

If you chose "YES" to be included in the directory, do you want your PHONE NUMBER in the directory? *Yes, include my phone number in the directoryNo, do NOT include my phone number in the directory

If you chose "YES" to be included in the directory, do you want to submit a PHOTO (see directions below) for your entry in the directory? *Yes, I will submit a photo to be used in the directoryNo, I do NOT want a photo of me in the directory

Submit

Directions to submit a photo for the Directory

• Submit a headshot of yourself only
• Email the photo to kbarry4299@gmail.com and put “Directory Photo” in the subject line of the email
• Include your first and last name in the body of the email