Donation and Event Request Form
Name of Requesting Organization *
Your answer
Organization Website *
Your answer
Category that best describes organization *
Required
Mission of Organization *
Your answer
Organization Address *
Your answer
Charitable Non-profit 501(c)(3) Number
Your answer
Contact Name *
Your answer
Contact Position/Role *
Your answer
Contact Email *
Your answer
Contact Phone *
Your answer
Event Name *
Your answer
Event Date
MM
/
DD
/
YYYY
Time
:
Event Location *
Your answer
What is the purpose of this event?
Your answer
Closest MOM's store location to event? *
Type of Donation Request *
Required
Expected Event Attendance *
Your answer
In what ways are you publicizing this event? *
Your answer
How will MOM's contribution be recognized? *
Your answer
How does this align with MOM's mission, to protect and restore the environment? *
Your answer
Has your organization already received a donation or event support from MOM’s within the last 12 months? If yes, when, from what store and what was the amount? *
Your answer
Have you worked with MOM's before for this event?
Your answer
Who did you work with?
Your answer
Is there any other information you think we should know?
Your answer
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