Meeting request 501(3)c and/or Certificate of Insurance Form

Instructions on how to request a 501(3)c documentation and/or a Certificate of Insurance

Who: 

1. Group in the fellowship that is a meeting in the current SDIC NA schedule where the facility requires 501(3)c documentation and/or a Certificate of Insurance. 
2. Area or Regional sub-committee/Area Service Committee/Regional Service Committee that is putting on an event where the facility requires  501(3)c documentation and/or a Certificate of Insurance

To request these documents, you will need to provide the following information. The starred (*) items are mandatory, so the requested documents can be provided with as little touch time as possible. If information is missing, it will delay getting the document:

Requestor:

Your Name: *

Phone: *

Email Address: *

Documents Requested for: *MeetingEventBoth

Meeting Information:

Meeting Name: *

Day of Week *SundayMondayTuesdayWednesdayThursdayFridaySaturdaySelect the day of the week the meeting occurs

Time of meeting *

Hours-120102030405060708091011Select

Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Select

AMPMAM

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Facility Point of Contact:

Facility Name: *

Facility Website/URL

Name of the individual: *

Point of contact phone number: *

Email Address: *

501(3)c Document: *YesNo

Certificate of Insurance: *YesNo

Event Information:

Event Name: *

Committee putting on the event *

Date *

Time *

Hours-120102030405060708091011Select

Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Select

AMPMAM

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Is the event on the regional calendar?YesNohttps://www.sandiegona.org/activities/

Facility Point of Contact:

Facility Name: *

Facility Website/URL

Name *

Point of contact phone number: *

Email Address *

501(3)c Document *YesNo

Certificate of Insurance: *YesNo

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