Charity Nomination Form

- NOMINATION FORM -

* Indicates required field

Your Name *

First

Last

Your Email Address *

Name of the organization that you are nominating *

Organization's Website *

Contact Name at the Organization *

First

Last

Contact Phone Number *

Contact Email at the Organization *

Has the organization been informed that someone from 100+ Men Who Care Quinte may be contacting them for more information and/or to notify them of successful selection? *

Yes No

Does the organization agree not to sell, give, or use the 100+ Men Who Care Quinte Region contacts for solicitations? *

Yes No

Organization's Mission Statement and/or Goals *

Which population(s) does the organization serve? *

What would donated funds be used for? *

Is the organization a registered not-for-profit charity able to provide tax receipts? *

Yes No

Charitable Registration # *

If selected, who should cheques be made out to? *

Submit

- NOMINATION FORM -

step three:

ATTEND A

"keepING it simple"

Need more information?

- NOMINATION FORM -

step three:﻿

﻿﻿ATTEND A﻿﻿ ﻿

"keepING it simple"

Need more information?

step three:

ATTEND A