Let Us Help You With Your Mail-In Registration Form

This form allows you to enter up to three individuals at the same address (or three variations of your name at the same address). For separate addresses, please use separate forms.

Please include a $3 processing fee for each completed form - check or money order payable to DMA - do not send cash.


Please fill in the required information below and click Submit. A completed form will be displayed; print, sign and mail it with payment to the address provided.

The following information is missing or invalid:
Primary name
Secondary names
* Country:   United States

Processing of your opt-out request requires that we share the information you have entered with client organizations for the sole purposes of removing matching data from unsolicited marketing lists. As a nonprofit organization, we provide this service to help consumers express their marketing preferences to businesses. It is not a tool to effectuate rights under any specific law including the California Consumer Privacy Act (CCPA).