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Donation Request Form
Your First Name:
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Your Last Name:
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Email:
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Phone Number:
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Organization Information
Organization Name:
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Organization Address:
Street:
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City:
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State:
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Zip Code:
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501c3 Federal Tax ID: (##-#######)
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501c3 IRS Determination Letter:
Please upload PDF or JPG
Organization & Donation Description
Organization's mission:
Please limit response to 25 words max.
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0/25 words
How does your mission align with Integrative Nutrition's mission of creating a ripple effect that will improve the health and happiness of the world?
Please limit response to 75 words max.
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0/75 words
What dollar amount would you like to request?
*
How will Integrative Nutrition be recognized for the donation (e.g. logo/mention on your site, etc)?
Please limit response to 75 words max.
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0/75 words
Are you interested in being considered for an enrollment donation?
Enrollment donations occur when we donate a set amount per enrollment at IIN during a predeterminded, publicized period of time.
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Yes
No
By what date do you need confirmation of this donation?
Please note: we can only consider requests made 30 days prior to donation confirmation date
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