Charitable Games Applications

Upon completion of the following form click the submit button,
you will then be able to download the appropriate application
as a .pdf document.
    
    
    
 
Organization Information
* Organization Name:  
* Phone Number:  
* Address 1:  
Address 2:
* City:  
* State:
* Zip:  
 
Tax Exempt Status
    
 
Contact Person's Information
* Contact Person's First Name:  
* Contact Person's Last Name:  
* Phone Number:  
If YOUR mailing address differs from the Organization's address enter it here
Address 1:
Address 2:
City:
State:
Zip:
Email Address:  
 
Which type of Charitable Gaming License are you interested in?
* Check all that apply
    
    
    
    
    
    
    
    
    


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