Charity Pre-Qualification Form for Members

THE WEBSITE HOST IS EXPERIENCE A TECHNICAL GLITCH AND TEMPORARILY CANNOT SUBMIT FORMS. IN LIEU OF FILLING OUT THE FORM BELOW, PLEASE EMAIL LAURIE RICHTER AT LAURIE100WOMEN@GMAIL.COM. THANK YOU!

Charity Pre-Qualification Form for Members

Please submit this form at least one week prior to the meeting so that we can confirm eligibility of the organization.

* Indicates required field

Nominating Member's Name *

First

Last

Nominating Member's Email Address *

Name of Organization You are Nominating *

Name of Person We Can Contact *

Contact Person's Email or Phone Number *

Address of Organization You are Nominating *

Line 1

Line 2

City

State

Zip Code

Country

Web Address of the Organization (if available) *

Is the organization a registered 501(c)(3) (IRS Certified Tax Free Status) charitable organization? *

YES NO

Submit

Charity Pre-Qualification Form for Members

Please submit this form at least one week prior to the meeting so that we can confirm eligibility of the organization.

www.100WomenWhoCareNSC.com

Contact Information

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Charity Pre-Qualification Form for MembersPlease submit this form at least one week prior to the meeting so that we can confirm eligibility of the organization.

www.100WomenWhoCareNSC.com

Contact Information

Facebook and Twitter

Charity Pre-Qualification Form for Members

Please submit this form at least one week prior to the meeting so that we can confirm eligibility of the organization.