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* 1. Name of Organization?

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* 2. Charitable or Not for Profit #

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* 3. Contact Name

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* 4. Contact Phone#

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* 5. Contact E-mail

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* 6. Address

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* 7. Town

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* 8. If selected as a Fuel Good Day recipient, what would your group use the funds for?

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* 9. Would any of your service group be able to help out at Fuel Good Day?  If so, approximately how many?

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