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Charity Nomination Form
If you are interested in nominating a charity, please be sure that they serve one of the following towns: Antrim, Bennington, Dublin, Francestown, Greenfield, Hancock, Harrisville, Jaffrey, Nelson, New Ipswich, Peterborough, Rindge, Sharon, Temple, and Wilton. This form must be received at least 15 days prior to the next meeting and MUST BE SUBMITTED AGAIN PRIOR TO EACH MEETING in order to be eligible. Details and deadlines can be found on the Charity Nominations page. Thank you!

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Email *
Name of Charitable Organization *
BRIEF Description of Intended Usage of Funding *
Charity URL or Facebook URL *
Employer Identification Number *
Year Charity Started *
How and in which towns relative to our community will funds be used. *
Checks Payable to: *
Name of Person Submitting Nomination *
Email *
Contact Phone: *
Address *
Name of Presenter if Different from Nominator *
Please Acknowledge Agreement to Rules Posted on Nomination Page *
Required
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