100 Women Who Care Rural Wellington Charity Nomination Form

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Please note only members of 100 Women Who Care Rural Wellington can nominate charities.

Member Name: *

Name of Charity: *

Address of Charity: *

Website of Charity: *

Mission Statement of Charity: *

The charity serves the following population: *

The charity is a registered charity able to provide tax receipts: *

Yes

If selected, someone from the charity will be available to speak at our next meeting to describe the impact of the donated funds. *

Yes

I'm not sure.

The charity agrees not to sell, give or use the 100 Women Who Care Rural Wellington contact information for solicitations. *

Yes

If selected, cheques should be made payable to: *

Date of nomination: * *

YYYY

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