Charity Submission Request Form

Name of Organization/Charity/Person *

First Name

Last Name

Primary Contact Person

First Name

Last Name

Secondary Contact Person

First Name

Last Name

Today's Date

MM

DD

YYYY

Has your Organization/Person/Charity submitted a formal request for support of any kind to our Elks Lodge in conjunction with this submission form?

Yes

No

Are you a registered charity?

Yes

No

Date of event or funds needed by

MM

DD

YYYY

Have you submitted this request for support to other organizations?

Yes

No

Have any other organizations provided support for the same request you are asking our Elks Lodge to support?

Yes

No

Have you ever requested any type of support from our Elks Lodge in the past?

Yes

No

Have you ever received support from our Elks Lodge in the past?

Yes

No