Data Request Form

First Name

Last Name

I am submitting request to... Required

Access: Know what information is being collected from me

Change: Correct or complete information about me that is inaccurate or incomplete

Erase: Request deletion of the information that has been collected from me

What email address(es) have you used to connect with us?

Please leave details regarding your request.

What email address should we use to respond to you?

Confirmation Required

Under penalty of perjury, I declare all the above information to be true and accurate.

I understand that, if I have requested deletion, the deletion of my personal data is irreversible and may result in the termination of services with this website.

I understand that I will be required to validate my request by email, and I may be contacted in order to complete the request.

I consent to having this website temporarily store my submitted information so they can process my request.

Thanks for submitting!

Data Request Form

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