By submitting this form, I request training and/or business counseling service from Missouri Procurement Technical Assistance Centers (Missouri PTAC), funded through the Defense Logistics Agency and/or the Missouri Small Business & Technology Development Centers (Missouri SBTDC) funded in part through a Cooperative Agreement with the U.S. Small Business Administration (SBA) or an SBA Resource Partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate these services, impact, and/or make improvements on services. I permit SBA/DLA or its agent the use of my name and address for SBA/DLA surveys and information mailings regarding SBA/DLA products and services (Yes 0 No 0). I understand that any information disclosed will be held in strict confidence. DLA and SBA will not provide your personal information to commercial entities.) I authorize SBA /DLA to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees not to: 1) recommend goods or services from sources in which he/she has an interest, and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against SBA/DLA personnel, and that of its Resource Partners and host organizations, arising from this assistance. Please note: The estimated burden for completing this form is 3 minutes. For Missouri SBTDC, you are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.