Leeds North and East Circuit

Data Consent Form

Leeds North & East Circuit

Please fill in the form below. When you click 'Send' it will be sent as an email to John Summerwill.
Alternatively, you may print a hard copy and post it to the Circuit Office. Click here for a printed form

Email address: * ESSENTIAL for online application

Title and Name (e.g. Mrs Name Surname): * ESSENTIAL

Postal address + postcode: (unless you wish to exclude contact by mail)

Phone: (unless you wish to exclude contact by phone)

Now please click on all the boxes below to which you consent; leave blank the ones you do not consent to.

I CONSENT TO THE LEEDS NORTH & EAST CIRCUIT CONTACTING ME BY:

Postal address

phone

I CONSENT TO MY CONTACT DETAILS BEING SHOWN OR GIVEN AS FOLLOWS

	Circuit Plan	Circuit Website	Circuit Directory	District & Connexion
Postal address
email address
phone numbers

Type here any other message:

A message from your email address will then be sent automatically to John Summerwill, who will update the circuit database.