Name of Organization * RequiredWho will the funds benefit?Name of Contact * Required First Last Address * Required Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone * RequiredFaxCompany WebsiteEmail * Required Enter Email Confirm Email Tax ID Number * RequiredDate of Event * Required MM DD YYYY Name of the Event * RequiredExpected Attendance # * RequiredWill you distribute theater brochures to your guests? * RequiredYesNoHow will the donation be used? * Required Auction Door Prizes Raffle Other If other please explain:By selecting Submit I understand that the John W. Engeman Theater at Northport reserves the right to refuse any donation request upon their discretion. In the event the John W. Engeman Theater at Northport donates an item, it will be used strictly for charitable purposes through auctions, door prizes, raffles etc. Donation tickets are valid for Thursday evening performances only. Other restrictions may apply. Any donation request submitted without a Tax ID Number will not be considered. I am aware of the John W. Engeman Theater’s policy to grant one (1) donation per year per organization.CommentsThis field is for validation purposes and should be left unchanged.