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*Official Organization or Program Name:
Acronym/Initialism:
*Phone:
Fax:
*Mailing Address:
Is the mailing address for public knowledge? Yes No
*Office Address:
Is the office address for public knowledge? Yes No
E-mail:
Web Site:
Describe the organization & eligibility for membership: Describe Organization
Please list any state or national affiliates:
Current officers and telephone numbers for public use (please indicate if business or home phone):
*President: Phone number: Home Office Vice-President: Phone number: Home Office Secretary: Phone number: Home Office Contact Person, if different from officers: Phone number: Home Office
*President:
Phone number: Home Office
Vice-President:
Secretary:
Contact Person, if different from officers:
Month in which officers are rotated:
Frequency of Meetings:
Time of Meetings:
Location of Meetings:
Do you have meeting facilities available for community groups? Yes No
If yes, is the facility wheelchair accessible? Yes No
Is there a kitchen facility available? Yes No
Capacity Is there a fee? Yes No
Do you provide special services or programs for the community such as:
Scholarships: Yes No If yes, briefly describe:
Classes: Yes No If yes, briefly describe:
Special Library Yes No If yes, briefly describe:
Special support for community groups Yes No If yes, briefly describe:
Other services or programs Yes No If yes, briefly describe:
Do you have free speakers available to the community? Yes No If yes, briefly describe:
* Required field
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