Donation Request Form
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Date: ____/____/______
Organization Name:
________________________________
Organization URL:
________________________________
Address: _________________________
City: __________ State: ___ Zip: ____
Contact Name: __________________
Contact Title: _________________
Contact Email: _________________
Contact Phone: _________________
Description of services provided and community served:
________________________________
________________________________
________________________________
________________________________
Name and Description of Event or Activity:
________________________________
________________________________
________________________________
Date of Activity: ____/____/______ through ____/____/______
Anticipated Number of Participants:
______________________
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