Donation Request Form

Organization Name(Required)

Summarize Focus of your Organization(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Nonprofit Status (i.e., 501(c)3)(Required)

Tax ID Number(Required)

Contact Name(Required)

First Last

Contact Title(Required)

Phone(Required)

Email(Required)

Do you have a sponsoring member from BH Runners Club?(Required)

Yes

Donation Amount Requesting(Required)

What Will Funds be used for?(Required)

When Are the Funds Needed(Required)

Please summarize how the requested funds will benefit your organization and our community.(Required)

Attach Supporting Documents if needed

Max. file size: 128 MB.

What efforts have you made to seek funding from other organizations and individuals?(Required)

If Approved Make Checks payable to:(Required)

73426