*ORGANIZATIONS NAME:

ORGANIZATIONS STREET ADDRESS:

CITY: STATE: ZIP:

*CONTACT NAME:

*CONTACT PHONE NUMBER:

*CONTACT E-MAIL ADDRESS:

IMPLEMENTATION TIME FRAME: SELECT ONE O-1 MONTH 1-3 MONTHS 3-6 MONTHS 6-9 MONTHS 9-12 MONTHS NOT SURE

*HOW DID YOU HEAR ABOUT FUND RAISING CONCEPTS: SELECT ONE E-MAIL FRIEND/ASSOCIATE PHONE CALL INTERNET SEARCH MAILING OTHER

*WHO SHOULD WE THANK FOR THE REFERRAL:

YOUR QUESTIONS: