Charitable Organization Nomination Form
In addition to completing this form, all nonprofits must have a current member (in good standing) nominate you for a quarterly award. Thank you for the work you do in the community
Organization Contact Person
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First Name
Last Name
Organization Name
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Preferred Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Organization Physical Address
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Street Address
Street Address Line 2
City
Postal / Zip Code
Provide bullet points of the following: mission; who you serve; key programs; other fundraising efforts. You may also provide brief explanations as needed.
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If selected, how do you plan to use the funds
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100+ Women Who Care Space Coast Nominating Member
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Full name of nominating member
Website
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Is the organization a registered 501 (c)3
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Yes
No
Application submitted, but not yet awarded
Upload the organization's logo here
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IMPORTANT NOTE: By clicking SUBMIT below, you agree you will not solicit our members directly for further contributions. You also agree not to create, sell or distribute a list with our members' contact info to invite them to events, programs or projects you have in the future, unless they express interest in participating. Do you agree?
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I will not solicit members for further contribution
I do not promise
Please verify that you are human
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Submit
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