Short Form Pc, Schedule A-2, Certification By Organization - 2009 Page 2

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List any names which will be used by the organization in connection with the solicitation of funds, other than the official
name which appears on page 1.
Types of solicitation activities in which you expect to engage (check all that apply):
Mass mailing
Via the Internet
Door-to-door
Raffle, beano, bingo or gaming event
Entertainment event
Sale of goods other than by telephone
Telemarketing without sale of goods or ads
Individual mailings
Telemarketing with sale of goods
Corporate solicitations
Telemarketing with sale of ad
Grant proposals
Other (please describe):
Identify the method or methods you expect to use for fundraising (check all that apply):
Professional solicitor*
Own employees
Professional fundraising counsel*
Volunteers
Commercial co-venturer*
* Provide applicable names and addresses:
Professional Solicitor Name:
Address:
City:
State:
Zip:
Professional Fundraising Counsel Name:
Address:
City:
State:
Zip:
Commercial Co-Venturer Name:
Address:
City:
State:
Zip:
Short Form PC – Schedule A-2
Page 2 of 4
Rev. 05/2009

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