CHARITY NOMINATION FORM
Completed Nomination Forms may be scanned and sent via email to info@100womenbrooklin.com, printed and mailed to 100 Women Who Care Brooklin c/o DG Smith Insurance, 31 Baldwin Street, Unit #6, Brooklin, ON L1M 0A2.

If you are making a Commitment as part of a team, each team may only submit one nomination per meeting and only one member per team can present to the group if this charity is selected.

Nominating member or team name: *
Your answer
Presenting team member’s name: *
Your answer
Presenting team member’s email address: *
Your answer
Organization
Name of organization you are nominating: *
Your answer
Contact name at the organization: *
Your answer
Organization Contact's phone number: *
Your answer
Organization Contact's email address: *
Your answer
Organization's Mission Statement: *
Your answer
The organization serves the following population(s): *
Your answer
Donated funds will be used by the organization to: *
Your answer
If your organization is not selected, would you like to resubmit it for nomination at our next meeting? *
Is the organization a registered not-for-profit charity able to provide tax receipts? *
If "yes" to the above question, their Charitable Registration # is: *
Your answer
If selected, will someone from the organization be available to speak at our next meeting to describe the impact of the donated funds? *
Has the organization been informed that a representative from 100 Women Who Care Brooklin may be contacting them for more information and/or to notify them of successful selection. *
Does the organization agree not to sell, give or use the 100 Women Who Care Brooklin contacts for solicitations? *
Does the organization agree that none of our donation will be used for administrative costs? *
If selected, cheques should be made payable to: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.