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Name: *

E-Mail Address: *

Contact Title *

The Name of Organization *

Organization's Web site *

Organization's phone *

Organization's address *

The Organization's Mission *

Short overview of the organization's history, accomplishments and current programs *

Briefly describe the proposed location for the sculpture installation *

Is the organization designated as a 501 ( c ) 3 charity? *

Yes
No

If not, please provide your charitable designation *

How did you hear about the Dabah Sculpture Donation Program? *

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