**Number of people this will effect:
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**Number of people your organization serves: |
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Other sources of funding |
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**Organization's Mission |
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**Type of request (please check all that
apply.): |
Sports/Fitness
Equipment
Sports/Fitness
Clothing
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**Briefly describe the request (please include date of event, location, number of participants, etc.
Please include sizes if requesting clothing.): |
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**Signature (Full Name) of Authorized Representative: |
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** MARKS ALL REQUIRED FIELDS |
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