FIELD DISSEMINATOR COMMISSION SLIP

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Field Disseminator Fundraising Commission Slip

Please fill out the Field Disseminator Commission Slip to have this sent directly to IAS Administrations:

Personal Information:

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Contact Information:

Selectee Information:

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Data protection/privacy: The data you provide on this form will be held in a secure database of IAS Administrations in Los Angeles. The data will be used for IAS membership administration purposes and to keep you informed of activities, offers and services of the Church of Scientology, and to send you membership-related mailings. By filling out and signing this form, you agree to the transfer of the data to IAS Administrations in the USA and to the passing of any of these data to those entities belonging to the Church of Scientology, who are commissioned to perform the request for information about Scientology on behalf of IASA, for the above purposes. IAS Administrations and those churches commissioned as above, fully respect your privacy. Your information is never disclosed to anyone outside IAS Administrations and the worldwide Church and its associated entities. You can verify your membership data held by IAS Administrations, or ask us to stop sending you mailings at any time simply by writing to us.

Thank you

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