Community Care Matching Program Request Form

Name and Location of Fas Gas Plus Station that has agreed to sponsor your event: (*)	Invalid Input
	Note: You must have the support and cash donation from a local Fas Gas Plus Station in order to be eligible for the Community Care Matching Program.
Fas Gas Plus Manager's name and Contact Information: (*)
Sponsorship requested dollar amount: (*)
	Note: Parkland Fuel Corporation will match a Fas Gas Plus cash donation up to a maximum of $250.00
Charity Name: (*)
	Note: Non-eligible groups include: Religious Groups, Individuals, Political organizations, and/or National organizations.
Registered Charity Number: (*)
Website of Event and/or Charity: (*)
	Contact Information:
First and Last name: (*)
Job Title: (*)
Email address: (*)
Phone Number: (*)
Street Address: (*)
City: (*)
Province: (*)
Postal Code: (*)
Provide a brief description of the Charity and how it helps the local community: (*)
Provide a brief description or summary of your request: (*)
Marketing media available to Fas Gas Plus (Newspapers, Radio, Banners, Logo visibility, handing out Litre Logs etc.): (*)	Invalid Input
How will the money raised directly impact the charitable organization: (*)	Invalid Input
	Note: All fields marked with () are required and must be filled in before submitting the request.*
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