Address: 

City: 

Province: 

Postal Code: 

Phone Number: 

Website: 

  

Registered Charity Number:

Reason for funding request (e.g. event sponsorship, new program, auction, general donation, etc.):

Amount Requested

$

This request is in support of a charitable event.

Event Name: 

Event Date: 

Event Location: 

Please list any opportunities for recognition of CUMIS' support:

I need a CUMIS Logo for promotional materials.

Logo Format:

JPEG PDF EPS

Colour Black & White Both