Nomination Form Not For Profit/Charity Organization

Nominate a local not for profit or charity to be considered to be one of the organizations chosen to receive a $5000+ donation.

If you don't have all of the information to complete the nomination form, send this form to your favourite organization and ask them to fill in the details. Self-nominations are welcome.

Here is a list of the organizations that have already been nominated.

Are you a Member of 100 Women Who Care Campbell River? *

Yes

Member Information

Member First Name

Member Last Name

Member Email Address

Member Phone

Is the organization a not for profit or charity? *

Yes

The organization will participate at the next event on November 23rd to host a table about their organization *

Yes

Not sure

Name of Organization *

Organization Address *

Organization Contact *

Organization Contact Phone Number *

Organization Contact Email

Organization Website

Organization Mission Statement

The organization serves the following population

The funds donated will be used to

The organizations current sources of funding are

Registered with CRA? *

Yes

Charitable Registration Number (nine digit number beginning with 1 or 8)

Charity able to issue tax receipts? *

Yes

Organization agrees not to sell, give or use the 100 Women contact information for solicitation. *

Yes

The organization agrees that our donation will NOT be used for administration costs. *

Yes