If you are interested in a 501(c)(3) status, 1023 Application
                              Please fill and submit the following form.
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All fields with an * are required fields.

 *Organization Name:
* Address:
* City:
* State:
* Zip:
* Telephone:
Fax:
E-Mail:
* Contact Person:
* Type of Organization:
* Director #1:
* SS# for Director #1:
* Director #1 Address:
* Director #2:
* Director #2 Address:
* Director #3:
* Director #3 Address:
Director #4:
Director #4 Address:
Director #5:
Director #5 Address:
Director #6:
Director #6 Address: