Instructions: Please complete form in BLOCK letters
NAME OF ORGANIZATION:
LEADER OF THE ORGANIZATION:
TITLE: (E.X. PRESIDENT; CHAIR)
CONTACT INFORMATION FOR ORGANIZATION
IS THIS A LEGALLY REGISTERED ENTITY?
NAME OF THE PERSON DOING THE REGISTRATION ON BEHALF OF THE ORGANIZATION:
(Note: Disbursement will be made to Committee/Organization Accounts for transparency. If an account does not exist in the name of Organization or Committee, an invoice of a product or service utilized for events can be provided.)
NAME OF BANK
Belize Bank Ltd
Heritage Bank Ltd
Atlantic Bank Ltd
I hereby confirm that all information given is valid, true and complete.
THIS INFORMATION WAS ENTERED BY:
If Other (please provide name)
Send me a copy of my responses.
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