Dominion Energy Charity Classic
Birdies For Charity presented by TowneBank

2019 Registration Form

Please complete the form below and click 'Submit' when you are done.

Charity Name

Charity State

Federal Tax ID (EIN)

Representative Name

Representative Title

Representative Email

Rep. Fax Number

Rep. Phone Number

Rep. Alt Number

Street Address

City

State

Zip Code

Please upload a copy of the Organization’s IRS Determination Letter and a current IRS Form W9.

To upload a file, Choose File, wait for file name to appear in line below, then select Upload File. The file name should then appear in the Uploaded Files list.

Upload Documentation

Uploaded Files:

By signing below, I consent to the Terms and Conditions of the Agreement above.

Signature

Date

(*) indicates required field

Status:

Date of Decision:

Dominion Energy Charity ClassicBirdies For Charity presented by TowneBank2019 Registration Form

Dominion Energy Charity Classic
Birdies For Charity presented by TowneBank

2019 Registration Form