Nomination Form

Organization Nomination Form

Fields with an asterisk are mandatory (other fields are optional).

Name of Organization*


Website *

Mission Statement

The donated funds would be used to

The organization serves the following area:


 The organization is a registered charity / not-for-profit able to provide tax receipts*


 If selected, someone from the organization will be available to speak at our next meeting to describe the impact of the donated funds*


If selected, cheques should be made payable to*


Nominating Member*


Nominating Email*

  I certify that, to the best of my knowledge and belief, the statements provided above are true and correct.*

Additional Comments

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