Application Form


Please print the following information and either fax or email it to us.

Organization Name: 
Contact Person: 
Phone Number: 
Fax: 
Email: 
Website: 
What services does your organization provide? 
  
Who is your target clientele by demographics and / or by location? 
  
What kind of fundraising do you already have in place? 
  
When are the funds needed, and how much are you looking to raise? 
  
If EBC approves your application what would the funds raised through our program be used for? Please give examples. 
  
Please provide any additional information that you feel is relevant. 
  



Please fax form to 780-454-8774 or email to info@everybeancounts.ca

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