Buckeye Rotary Club

BUCKEYE ROTARY CLUB - COMMUNITY BINGO APPLICATION

PURPOSE: A Non Profit Organization (NPO) may request a special program from the Buckeye Rotary and Community Bingo, where (upon approval) the NPO group / organization is assigned a month or months within the year, and the NPO would promote the play of Bingo by their organization and within that month. Upon the conclusion of that effort, the NPO would receive a check equal to 25% of the gross income generated by their group / organization.

Please fully answer all of the below listed questions. You may include one brochure describing your organization or program, please do not send any other information.

Application Date: Name of Organization: Non-Profit Tax ID#: Contact Person: Organization Mailing Address: Phone #: Fax #: E-mail Address: Website:

1. What is your Mission Statement?

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2. How many years has your organization been in existence?

3. Who and how many people do you serve on an annual basis?

BUCKEYE ROTARY CLUB P O BOX 594 BUCKEYE AZ 85326 4. What are your major funding sources?

5. Briefly explain the plan and timeline for implementing the specific project you are requesting to be funded.

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Authorized Signature (print name)

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Authorized Printed Name

Date:______

BUCKEYE ROTARY CLUB P O BOX 594 BUCKEYE AZ 85326 Mail completed applications, and copy of certificate of non-profit status The Rotary Club of Buckeye P.O. Box 594 Buckeye, AZ 85326

BUCKEYE ROTARY CLUB P O BOX 594 BUCKEYE AZ 85326