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