Organization(Required) Contact Name(Required) First Last Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Amount Requested(Required) Date Required (mm/dd/yyyy)(Required) Month Day Year Describe the purpose of the donation: event sponsorship, items needed, etc.(Required)Describe the value to UEC: logo on program; name at event, tickets to event, etc.(Required)Has UEC sponsored/donated to your organization in the past?(Required) Yes No What and when?(Required) List any additional relevant information/commentsMember Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.The above is correct to the best of my knowledge, and if the donation is approved, the goods and/or money will be solely used and expressly for the purpose listed.Member Electronic Signature (Full Name)
