Charity Register Form

Social Datebook & Charity Register 2013 - 2014

Please complete and submit this form by August 30, 2013.

This form will be submitted to the Palm Springs Life Editorial Department.

The Fields with RED Headers are required!

Charity Name:
Contact Person:
Address:
City: State: Zip:
Phone: Fax:
E-mail:
Website:
Mission Statement:

SAMPLE:

ABC Recovery Center Inc. Provides an environment for alcoholics and drug addicts to achieve lifelong sobriety and to re-enter the community as healthy and responsible individuals
Name of Primary Fundraising Event:
Location of
2013-2014 Event:
Date of
2013-2014 Event:
Theme/Description of Event:
Number of Years Event Held:
Attire:
Chairperson(s):
Honorary Chairperson(s):
Ticket Price(s):
After you have completed the form, please click the "SUBMIT" button below —