Community Donation Request Form
Organization Name (Check Payment to)
*
For (Activity/Event/Group)
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Point of Contact
Name
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Sponsorship Details
Amount Requested
*
Non-Profit
*
Yes
No
Is the activity for which the donation/sponsorship is sought non-political?
*
Yes
No
Describe how the donation/sponsorship will benefit members from throughout BREA's service territory:
*
Describe how the organization will recognize BREA if a donation/sponsorship is provided:
*
Date of Activity
*
-
Month
-
Day
Year
Date
Anticipated Total # of Participants:
*
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Supporting Documents
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Signature
*
Applicant Signature
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: