Charity Pre-Qualification Form for Members

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