Request to remove Unsung Heroes Network listing

Complete all required information fields (indicated with an asterisk *) and click SUBMIT at the bottom of the form to have listing information removed from the Unsung Heroes Network.
APPLICANT INFORMATION
First name *
Last name *
Street address *
Address/Apt#/Suite
Town/City *
State/Province/Region *
Country *
Zip/postal code *
Daytime telephone number *
E-mail *
Re-type e-mail *
IN AN EFFORT TO PROTECT THE RIGHTS OF OUR MEMBERS AND TO ENSURE THAT THIS REQUEST TO HAVE INFORMATION REMOVED FROM OUR WEB SITE HAS BEEN AUTHORIZED BY THE ORIGINAL APPLICANT, THE FOLLOWING SECTION MUST BE COMPLETED
THE PERSON SUBMITTING THIS REQUEST FOR INFORMATION REMOVAL IS *	The SAME person who submitted the application form requesting to be listed on the Unsung Heroes Network ANYONE ELSE (explain your authority below)
Don't use quotation marks (") in the text box
If you are ANYONE other than the person who originally submitted the application form, explain your authority to request that the listing is removed from the web site
The original applicant will be contacted and notified of this request to have information removed from the web site!
REMOVE UNSUNG HEROES NETWORK WEB SITE LISTING INFORMATION
INDICATE HOW THE CONTACT LISTING INFORMATION APPEARS ON THE UNSUNG HEROES NETWORK WEB SITE
Membership IDENTIFICATION number (from web site listing panel)
Member identification number *
MAIN CONTACT INFORMATION *	Uses my NAME (as indicated in APPLICANT INFORMATION above) Uses an alternate name (indicated below)
This is the name I selected as my MAIN CONTACT name
ACKNOWLEDGEMENT - By clicking the SUBMIT button, I hereby knowingly authorize Longshot Productions (2007) Ltd., my intended recipient, to remove the contact information, music files or links to my personal URL address from any web site owned, managed and operated by Longshot Productions (2007) Ltd. I HAVE THE AUTHORITY TO REQUEST THAT THE INFORMATION BE REMOVED FROM THE WEB SITE.
CHECK THIS BOX *	I have read and agree with the acknowledgement
Enter the code as it is shown: *
THEN SELECT THE SUBMIT BUTTON BELOW