subject_line
Name of FORBS Member/Associate:
*
Organization /
Event / Contact Info
Recipient ORGANIZATION and/or EVENT:
*
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Contact Name:
*
Contact Title:
Email Address
Phone Number
Description of Community Service Provided
*
Was Discount 50% or more?
Yes
No
Estimated value of the Donation/Discount
Please select the category which best describes the recipient event:
*
Children's Charity
Elderly Care
Homeless Shelter
Animal Rescue
Education Program
Healthcare Organization
Environmental Cause
Other
Other
Date of Community Service:
*
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