Contact Information for Release Authorization Form
Important Note:
it's only necessary to fill out this form once, either online or using TMA's paper form. If you have already provided your "Contact Information for Release Authorization" to TMA, please don't fill out this form again unless absolutely necessary due to changes in your contact information.
Please confirm your identity:
Name
Client number
(8 digits only)
Address
Date of birth (yr/mo/day)
Contact information for release authorization:
Please specify below the contact information you authorize for release to the women you request to contact. You can choose any or all of the contact information options listed below.
Email
Address
Tel
Fax