First Name
Last Name
Name of Organization
Address
Postal code
City
State
Phone
*
Email
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Please describe what your organization does or is involved in.
Is this organization a certified 501 © 3 corporation or other charitable organization under the U.S. Internal Revenue Code?
Yes
No
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Tax ID
Requested Contribution
If this is for an event, what is expected attendance?
Please describe how funds will be used
Is there any advertising offered? If so, please describe
I attest that the information in this application and its attachments is true and accurate and this request is not made for the purpose of influencing any governmental or legislative decision or for any unlawful purpose.:
Yes
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