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Nonprofit Contact Information Form
Organization Legal Name
*
Organization DBA Name
Organization Contact Information
Organization Phone
*
Organization Email
*
The organizations email should be a unique, generic email not associated with anyone in the organization: for example, info@nonprofit.org
Verify Email
*
Organization Mailing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Executive Director Name
First Name
Last Name
Executive Director Email
Verify Email
Executive Director Phone
Additional member of your organization to receive IMPACT 100 emails
Additional email recipient
Name
First Name
Last Name
Position in the Organization
Email
Verify Email
Phone
