July 28, 2003

Model Association Fax Consent Form

1 min

MODEL ASSOCIATION FAX CONSENT FORM

FOR COMPANY/ORGANIZATION CONSENT

Company/organization name for which consent is being provided:

_____________________________________________________

Name of person authorized to provide such consent:

_____________________________________________________

Fax number(s) for which consent is being provided:

_____________________________________________________

I understand that by providing the fax number(s) above, on behalf of the company/organization specified above, I am authorized to and hereby consent for the company/organization to receive faxes sent by or on behalf of ABC ASSOCIATION, ABC FOUNDATION, ABC SERVICES CORPORATION, AND/OR ABC PAC.

Signature:  ___________________________________________

Date:  _______________________________________________

*  *  *  *  *

FOR INDIVIDUAL CONSENT

Name of person providing consent:

_____________________________________________________

Fax number(s) for which consent is being provided:

_____________________________________________________

I understand that by providing the fax number(s) above, I hereby consent to receive faxes sent by or on behalf of ABC ASSOCIATION, ABC FOUNDATION, ABC SERVICES CORPORATION, AND/OR ABC PAC.

Signature:  ___________________________________________

Date:  _______________________________________________