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2. Organizations Name*
3. Email Address*
5. Address (Street, City/Town, State, Zip)*
6. Proof of 501c3 status*
8. Name of Director (Applicant Name)*
9. Title*
10. Phone Number*
12. Name of Board of Directors, Chair*
13. Email Address*
15. Description

    Text must be edited, spell checked and legible. Copy/past as plain text only. 

    
    

    
    

17. Poster

    jpg's preferred

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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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