| Organization Name: |
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| Contact Name (Last, First): |
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| Address: |
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| City/State/Zip |
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| Contact Telephone Number: |
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| Contact Email Address: |
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Organization Mission Statement:
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| Describe the proposed event(s) for which
your organization is seeking partnership: |
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| Explain the role you would envision
Basics Project playing: |
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Is your organization a
non-profit organization?
□ Yes □ No
If yes, please explain: |
Is your
organization non-partisan? □ Yes □ No
If no, please explain: |
| Is your organization willing
to provide information from both sides of the issue being addressed?
□ Yes □ No |
| Is your organization
currently engaged in producing an event?
□ Yes □ No |
Is your organization
affiliated with any other organization?
□ Yes □ No
If yes, please explain |