Donation Request Name of Organization*Who will the funds benefit?Name of Contact* First Last Address* 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*FaxCompany WebsiteEmail* Enter Email Confirm Email Tax ID Number*Date of Event* MM DD YYYY Name of the Event*Expected Attendance #*Will you distribute theater brochures to your guests?*YesNoHow will the donation be used?* 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.NameThis field is for validation purposes and should be left unchanged.