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EXT - Trust - NPA Registration Form
APPLICANT INFORMATION
Organization Information
Organization Legal Name
BC Registry Incorporation/Registration or Business Number (if applicable)
Mailing Address
City
Province
Postal Code
Format: A1A 1A1 or a1a 1a1
Signing Authority Contact Information
Signing Authority Name
First
Last Name
Last
Phone Number
Email Address
Is Signing Authority same as the Project Contact?
Check if Signing Authority information is the same as the Project Contact information.
Primary Contact Information
Primary Contact Name
First
Primary Last Name
Last
Phone Number
Email Address
Primary Contact Name
First
Primary Last Name
Last
Phone Number
Email Address
Organization Mandate
Maximum 120 words allowed.
Have you previously accessed the Non-profit Advisors program?
Yes
No
Not Sure
Registration Type
Society
Cooperative
Charity
Other, please specify
Other, please specify
Choose one of the following options that best reflects the type of work in which your organization engages.
Arts, Culture and Heritage
Community
Economic
Environment
Recreation
Social
Other, Please specify
Other, Please specify
What type of support are you interested in receiving from the Non-profit Advisors program?
Planning and direction
Recovery planning / hazard risk assessments
Material resources
Human resources
Financial management
Risk management
Administration/management
Governance
Community relationships
Other, please specify
Other, please specify
Select all that apply.
What programs / services does your organization currently offer?
Who benefits from your program/services, and what region(s) do you serve? If your organization includes program/services that fall outside the Basin
region
please explain.
Number of Board Members
Please enter a numeric value.
Number of staff (FT/PT)
Please enter a numeric value.
Number of active volunteers
Please enter a numeric value.
Approximate Annual Budget
Please enter a numeric value.
Is there anything else you would like us to know about your situation that may help us assist you?
What is the main, and first way you heard about this program?
Direct from Trust staff
Trust Website
Email from the Trust
Our Trust monthly eNewsletter
Advertisement
Social Media
Word of mouth
Other
What is the main, and first way you heard about this program?
Would you like to receive email correspondence from the Trust?
Yes
No
Please enter your email address
Does your organization have social media accounts?
Share your account names and we can connect.
Facebook
Instagram
LinkedIn
How do you like to receive news and hear updates from the Trust?
Direct from Trust staff
Our Trust Monthly eNewsletter
Trust Website
Email from the Trust
Social Media - preferred platform
Social Media - preferred platform
Advertisement
Other - please list
Other - please list
DECLARATION
1. I am authorized to submit this application on behalf of the applicant organization.
2. The information I have provided in this application is true, accurate and complete in every respect.
3. By submitting this application, I hereby acknowledge that written and verbal advice provided through the Non-profit Advisors Program by an Advisor or associated consultants is given in good faith based on the information available. This advice is not guaranteed by the Advisor, consultant, or Columbia Basin Trust. Clients must use their own judgment when considering any advice provided and implement recommendations at their own discretion.
4. I further agree to indemnify and save harmless the Trust, its officers, directors, employees, servants and agents from and against any and all claims and demands, including those for any personal injury or for damage to or loss of property, arising from the Client’s participation in the Program.
5. By submitting this application, I hereby acknowledge that Columbia Basin Trust may disclose this application, and the information contained herein—including but not limited to name, location and the amount and nature of any related funding—to the public, individuals or any other entity to the extent allowed by FOIPPA.
6. I further agree that Columbia Basin Trust may proactively disclose to the public my name and location and the amount and nature of funding granted.
7. Any questions regarding such may be directed to: FOIPPA Inquiries, Senior Manager, Information Services, Columbia Basin Trust, 300–445 13 Avenue, Castlegar, BC, V1N 1G1, 1.800.505.8998.
I have read and agree to the declaration above.
*
I Agree
Date
Applicant Name
*
Applicant Title
*
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