100+ Women Who Care Victoria

Charity Nomination Form

Please ensure that all information is up-to-date and accurate for your chosen charity. All nominated charities must be registered with CRA and be able to provide tax receipts, and must serve the Greater Victoria Area. If any information is missing, the form will be rejected, so please complete each field. Thank you so much for submitting a nomination!

* indicates required

Member Email Address *

Member First Name *

Member Last Name *

Member Phone Number *

Name of Nominated Charity *

CRA Registration Number *

Charity Website *

Contact Name at Charity *

Charity Contact Phone Number *

Charity Contact Email

What is the Charity’s Mission Statement? *

In one sentence

Who does the Charity serve? *

One sentence, please

What would donated funds be used for? *

One sentence, if possible

If selected, cheques should be made payable to: *

Does the Charity know we will be contacting them?

Charity agrees to the following terms:

Will arrange for a speaker at our next meeting
Will only use our member database for tax receipting
Will NOT solicit our members in the future for any reason