Donation Request Form
*
Your First Name:
*
Your Last Name:
*
Email:
*
Phone Number:
Organization Information
*
Organization Name:
*
Organization Address:
Street:
*
City:
*
State:
*
Zip Code:
*
501c3 Federal Tax ID: (##-#######)
501c3 IRS Determination Letter:
Please upload PDF or JPG
Organization & Donation Description
*
Organization's mission:
Please limit response to 25 words max.
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.
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.
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.
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
*
Indicates Response Required