Charity Nomination Form

Charity PRE-QUALIFicATION Form

Please submit this form at least one week prior to the meeting so that we can confirm eligibility of the organization.
(Items with ARE REQUIRED)*

* Indicates required field

Nominating Member's Name *

First

Last

Nominating Member's Email Address *

Name of Organization you would like to nominate if they pass our vetting process *

Name of person at Organization we can contact *

Contact person's email or phone number *

Address of Organization *

Line 1

Line 2

City

State

Zip Code

Country

Web Address of the Organization (if available) *

Is the Organization a registered 501(c)(3) (IRS Certified Tax Free Status) charitable Organization? *

YES NO

Submit