Charitable Organization Registration Form - Ocoee Founders Day

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7th Annual Chick-fil-A 5K & Kids Fun Run
Saturday, November 4, 2017
2017 Beneficiary Application Form
APPLICATION DUE DATE: April 28, 2017
Organization’s Legal Name _______________________________________________________
Contact Name __________________________________________________________________
Contact Title ___________________________________ Phone (____) ____________________
Mailing Address ________________________________________________________________
City_________________________________ State __________ Zip Code __________________
Email ____________________________ Website _____________________________________
Federal EIN/Tax ID # (Nine digits) __ __ - __ __ __ __ __ __ __
What is the mission statement of your charitable organization?___________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What percentage of revenue goes towards your mission? ________________________________
______________________________________________________________________________
How many years has your organization been in existence?______________________________
□
□
Is your charitable organization a 501(c)(3)?
Yes
No
How does the local community benefit from your charity? ______________________________
______________________________________________________________________________
______________________________________________________________________________
Requirements of the beneficiary for the Annual Chick-fil-A 5K & Kids Fun Run:
∙ Attend all 5K meetings-must have a representative present
∙ Contribute literature, etc. for goodie bag
∙ Speak during pre-race
∙ Have an information table at the 5K
∙ Have members set-up and tear down race
∙ Attend wrap-up meeting
∙ Organization must have an Ocoee address
Please attach any additional information regarding your charitable organization.
*Top 2 finalists will have a group interview/facility visit*
Mail completed form to:
Toren Hogan
City of Ocoee Parks and Recreation Department
1820 A.D. Mims Rd.
Ocoee, FL 34761

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