Date*

Organization requesting support*

Organization address*

Contact Person Name and Title*

Phone Number*

Email Address*

Organization's Mission*

Name of the event program or project*

Date of event program or project*

Is your organization classified as tax-exempt under sections 501(c) or 170(c) of the United States Internal Revenue Code, or a public agency? *

Select One Non-profit Public Agency No

Please type N/A if this does not apply to your organizaton.

Organization's Tax ID #*

Dollar amount or in-kind services requested*

Please provide a brief description of how Port of Palm Beach's resources will be used*

Which of the following targeted areas does this program support*

Select One Maritime Commerce Community Outreach Economic and/or Workforce Development Environmental Awareness

Has the Port of Palm Beach supported your organization in the past?*

Select One Yes No

If yes, when and for what event, program or project?

How will Port of Palm Beach be recognized as a sponsor/ participant*

Please attach a document providing overview of the organization*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Please attach a copy of W-9*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Please attach copy of 501(c)3 Designation Letter*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)