Section One - Agency Information

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* 1. Agency Name

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* 2. Executive Director Name

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* 3. Executive Director e-mail address

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* 4. Registered Charitable Business Number

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* 5. Street Address

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* 6. Name of Program you would like funded

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* 7. Program Staff or Volunteer Contact name 

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* 8. Phone Number

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* 9. E-Mail address for Program Staff/Volunteer

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* 10. E-Mail address for person completing this LOI

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