Community Giving Request - Impact Athletic Center

Community Giving Request Form

Organization Name: *

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Organization Type: *

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Mission or Purpose of Organization: *

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Website URL (if available):

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Tax Status, (e.g. 501(c)(3) - if applicable):

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Tax ID / EIN (if applicable):

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Years in operation: *

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Contact Name: *

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Title / Role: *

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Email Address: *

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Phone Number: *

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Mailing Address: *

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Type of Request: *

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Amount Requested (if applicable):

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Description of what is being requested: *

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Date donation is needed for/by: *

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Who will benefit from this donation? *

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How does this request align with our business and community values? *

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Does this organization/individual Utilize Impact Athletic Center?

Yes

No

If yes, what service does this organization/individual utilize at Impact Athletic Center?

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How will Impact Athletic Center be recognized as a donor? *

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COMPLETE IF REQUEST IS FOR EVENT-BASED

Event Name:

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Event Date(s):

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Event Description/Purpose:

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Expected Number of Attendees:

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Contact Us

Phone: (518) 579-4000Address: 390 NY-Route 146 Halfmoon, NY 12065Email: guestservices@impactathleticsny.com