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Community Outreach Request
Organization Name *
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Organization Purpose *
Please describe.
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Organization Tax ID *
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Organization Website *
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Contact Person *
Name and Role
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Street Address *
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City, State, Zip *
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Email *
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Phone Number *
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Event Date *
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Donation Target Date *
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YYYY
Donation Requested *
Please describe.
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Advertising Provided *
If yes, please describe and indicate whether a logo is required.
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