National Security Agency Logo  INFOSEC Assessment Methodology Logo PRIVACY ACT STATEMENT. The authority for collecting
the information requested is contained in 50 U.S.C. 402 note; P.L. 86-36.
NSA’s Blanket Routine Uses, found at 58 Fed. Reg. 10,531 (1993).
NSA is not requesting your Social Security Number.
The information collected will be used to update the INFOSEC
Assurance Training and Rating Program Internet Web site.
Disclosure of information is voluntary.

Release Authorization:

I, ____________________, authorize the release of my name and contact information to be placed on the INFOSEC Assurance Training and Rating Program Internet Web site, as having completed the INFOSEC Assurance Assessment Methodology course. I specifically authorize my name, telephone number and e-mail address, as reflected below to be listed on the Web site. Additionally, I understand that it is my responsibility to keep the Web site manager/operator appraised of any changes to this information so the listing can remain current. I further understand that this data is being provided to the public for information purposes only.

NSA shall have no liability with respect to its obligations under this arrangement or otherwise to me, or the company for which I work, for special, incidental, consequential, punitive, or exemplary damages as a result of posting information on the Web site. In no event shall NSA be liable for lost revenue or business due to an interruption in the availability of the Web site. NSA makes no claims as to the availability of the Web site or to the accuracy of the information contained on the Web site.

I understand that the inclusion of my name in this listing does not constitute an endorsement, recommendation or warranty of my services on the part of NSA or any other government agency. Endorsement of a non-Federal entity may be neither stated nor implied by NSA or NSA employees in their official capacities. As a result, I will not claim or imply the existence of NSA endorsement, recommendation, or warranty of my services covered by this arrangement. I understand that the Web page is merely intended to distribute the contact information of individuals that have completed the INFOSEC Assurance Assessment Methodology course.

The participation by NSA in this arrangement shall not be construed in any way as a commitment to me, or the company for which I work, of any future procurement of my services, nor in any way be permitted to provide a basis or argument for sole source procurement that might otherwise prevent full and open competition.

This document constitutes the total arrangement of the parties. No promise of payment, either express, or implied, is made by the Government or to be imputed from other sources.

Signature: ____________________________________ Date:___________________
Printed Name: ______________________________ Date of IAM course: _____________
E-mail address: ____________________________________________________________
Telephone number(s): _______________________________________________________