Our purpose is to Make A Difference in the lives of those in need and our environment.

Fundraising Participant Application

Organization Information

*Organization Name:	*Organization Type:

*Make Fundraiser Checks Payable To:

*Address 1:

Address 2:

*City:	*State:	*Zip Code:

*Primary Contact Name:	*Primary Contact Phone:

*Primary Contact E-mail:


Shipping Information (if different from above address)
Shipping Contact Name:

Address:

City:	State:	Zip Code:


Payment Address (if different from above address)
Address:

City:	State:	Zip Code:


Additional Fundraiser Info
*Expected Fundraiser Start Date:
*Please briefly describe what cause the fundraising proceeds will benefit:

*How did you hear about us?	*Who is your fundraiser consultant?

	Please type the name of your Fundraiser Consultant. If you did not have one, please type "NONE".