Charity Nomination Form

Charity Nomination Form
Date

MonthDayYear
Date
Team Name (If Applicable)
Member Name

First NameLast Name
Member E-Mail
example@example.com
Charity Name
Charity Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Charity Contact

First NameLast Name
Charity Contact E-Mail
example@example.com
Charity Contact Phone Number
Format: (000) 000-0000.
Charity Website
Please note that only registered charities (i.e. those with a Tax ID) are eligible for donation consideration.
Charity Status
Charitable Registration No. if you know it
Have You Contacted The Charity?
Should be Empty: