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1. About Me

First Name*

Last Name*

Personal Email Address*

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Mobile Phone Number*

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How did you hear about us?*

2. About My Organization

Organization Name*

Organization type*

Organization website

Is your organization a nonprofit?*

Note: Certain fundraisers are limited to nonprofits.

Note: Later on, you’ll need to upload a document evidencing nonprofit status (e.g. tax exempt certificate).

How large is your network?*

Your role/responsibility*

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Your work email*

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Organization contact phone number*

Extension

Organization Street Address 1*

Street Address 2

Zip Code*

City*

State*

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