Organization Name

Location LocationNorth LoganProvidence

Tax ID / Tax Exempt ID

Address

City

State StateAlaskaAlabamaArkansasArizonaColoradoCaliforniaDelawareConnecticutDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaKansasIowaLouisianaKentuckyMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew YorkNew MexicoNorth DakotaNorth CarolinaOklahomaOhioPennsylvaniaOregonRhode IslandSouth CarolinaTennesseeSouth DakotaUtahTexasVirginiaVermontWest VirginiaWashingtonWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific

Zip Code

Email Address

Phone

Please tell us a little about your organization

Name of Campaign

Fundraising Sales Goal

Program Start Date

Program End Date

Give your campaign a “charity-short-name” which will become a page in our website

Show your Organization’s $ goal on your campaign page? Show your Organization’s $ goal on your campaign page? Yes No

Show your current total raised $ on your campaign page? Show your current total raised $ on your campaign page? Yes No

Please tell us a little about your campaign