Name of Organization*:

Name of Event*:

Date of Event*:

Place of Event*:

Time of Event*:

AM or PM:

Anticipated Number of Attendees*:

CONTACT PERSON'S INFORMATION

First Name*:

Last Name*:

Street Address*:

City*:

State/Province:

Zip/Postal Code:

Contact Person’s Phone*:

Contact Person's Email*:

What type of donation are you asking for?(ex.: service, cash discount, product)*:

Amount of Donation Request*:

Please explain how this event will benefit the community*:

Please describe how Horizon Resources will receive recognition for the donation*:

Security Code: