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2. Date:*
   Date:

   Date:
4. Organization requesting support:*
5. Organization address: *
7. Contact Person Name and Title*
9. Phone Number: *
10. Fax:
11. Email:*
13. Organizational Mission:*
15. Name of event program or project?*
16. Date(s) of event program or project?*
18. Is your organization classified as tax-exempt under sections 501(c) or 170(c) of the United States Internal Revenue Code, or a public agency? *
    -- Select One --Non-ProfitPublic AgencyNo
19. Organization's Tax ID #*

    Please type in N/A if this does not apply to your organization. 

21. Dollar amount or in-kind services requested? *
23. Please provide a brief description of how Port of Palm Beach's resources will be used. *
25. Which of the following targeted areas does this program support? *
    -- Select One --Maritime CommerceCommunity OutreachEconomic and/or Workforce Development Environmental Awareness
27. Has the Port of Palm Beach supported your organization in the past? *
    -- Select One --YesNo
28. If yes, when and for what event, program or project?
30. How will Port of Palm Beach be recognized as a sponsor/participant? *
32. Please attach a document providing overview of the organization*
33. Please attach a copy of W-9*
35. Please attach copy of 501(c)3 Designation Letter*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field