UU OUTREACH AUCTION
for Bergen County
uuoutreachauction@gmail.com
PARTICIPATION REQUEST FORM
Please complete the attached request form and submit it electronically to the email address above along with the most recent financial statements and evidence that your organization is eligible to receive tax deductible contributions under current IRS law (e.g. most recent IRS 501(c)(3) document). Forms must be filled in completely and returned no later than July 15, 2016.
Date: __________________________________________
Legal Name of Organization: ________________________
Executive Director: _____________________________________
Contact Person (if not Executive Director)- Name ________________________ Title:_____________________________
Address of Organization: ________________________________________________________
Phone: ___________________________________________
Fax: ___________________________________________
Email: ___________________________________________
Website: ________________________________________
Mission Statement and Brief History:
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Statement of Need: (Provide a general statement of need with rationale for the proposed service or activity. Describe the population to be served and the issues to be addressed.)
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
