Donation | Mount Nansen

donation requests

To request a donation from Mount Nansen Remediation Ltd. Partnership for an event or an organization, please complete the donation request form below.

Donation requests must be submitted at least two weeks prior to the date funds are needed.

Contact Information About Person Submitting Request

Name of organization requesting donation (list all that apply):

Type of Organization

Name & Title of person submitting request

Phone

Purpose of Donation Request

Event Title

Event Date

Brief description of what the funds will be used for?

How will this initiative benefit the community?

Requested Contribution – Check All That Apply

Financial Donation – Total Amount ($)

Requested

In-Kind Support (materials, equipment, etc.) please specify:

Requested

Recognition of Contribution

How the company will be recognized (optional):

Logo placement on event materials

Acknowledgement in community newsletter/social media

Invitation to attend event

Other

Authorization – to be Completed by MNRLP Representative

Authorized Representative (signature)

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Printed Name & Title

Date