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Name of Applicant |
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Mailing Address of Applicant |
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Phone Number |
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Date Request Made at Washington State
Convention and Trade Center |
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Time of Day of
Request Made |
| Nature of Request: . . . . . . . . . . . . |
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| Description of Record Requested: . . . . . . . . . . . . |
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| Said Records Have Not Been Requested to Provide Access to Lists of
Individuals for Commercial Purposes. |
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Signature |
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Signature (please print) |
| Request: Approved |
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Date |
By . . . . . . . . . . . .
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| Denied Date: . . . . . . . . . . . . |
| Reasons for Denial: . . . . . . . . . . . . |
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| Referred to . . . . . . . . . . . . |
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Date |
By . . . . . . . . . . . . |