To complete ONLINE TOTALLY, CLICK HERE

You must mail in either choice below:

To complete online and then print out form and mail in, CLICK HERE
To print out form and fill out by hand and mail in, CLICK HERE

MCB Permission Statement

I hereby give Missouri Community Betterment permission to use my name, photograph, any information submitted in conjunction with the MCB Awards Competition, information about my circumstances and assistance provided to me by MCB. I understand that this will be used only in educational materials such as MCB brochures, web site materials or news releases to help others understand how MCB programs can help rural communities. This information is not to be used for any commercial, money-making purpose. I will be allowed to review the material relating to me, and approve of its accuracy. This information may be released by MCB for the purpose of conducting outreach activities with the general public. I understand that by signing this consent form, I am waiving any privacy interests I may have in relation to this information under the Privacy Act, 5 U.S.C. 552a, the Freedom of Information Act, 5 U.S.C. 552, and the Trade Secrets Act, 18 U.S.C. 1905.