Midas Kids - Fundraising

Please enter information regarding your organization:

Fields marked with red asterisk (*) are required.

*Organization Name:
*Type of Organization:
If Other, please specify:
*Address of Organization:
Address Line 2:
*City:
*State/Province:
*Zip/Mail Code:
Country:
*Contact Person:
*Title:
*Telephone Number:
Fax Number:
*Email Address:
*How do you intend to utilize the Midas Fundraising Program?
*Frequency:	Year Round One-Time Event
Comments: