EmailMe Form - Donation and Grant Request Form

Name of Organization *

Organization's Website

Contact Person *

Email *

Phone Number *

### - ### - ####

Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Can you display an ERIK'S link on your website? *

Website where ERIK'S link would be displayed:

Description of Organization's Focus & Mission *

Does Organization have 501 (c)(3) non-profit status? *

Yes

No

Tax Exempt ID#

Name and location of project or event *

Date of project or event: *

MM / DD / YYYY

Type of Support Requested *

Amount requested *

Detailed description of the project or event for which support is requested *

How does the proposal fit with Erik's mission? *

Promotes bicycling, snowboarding, skiing, and/or skateboarding

Supports bicycle safety & advocacy efforts

Benefits a non-profit organization dedicated to health and wellness

Encourages health and wellness through active lifestyles

(select all that apply)

How many people are expected to participate in, and/or be effected by this event or project? *

Describe promotional materials and how supporting organizations will be included *

Measures for evaluating success

Additional Information

Please provide any additional information as it relates to this request.