Group Name: _____________________________________________________________

Mailing/Street Address:______________________________________________________

City: _____________________________

Postal Code: ___________________________

Date: ___________________________

Email: ________________________________

Yes

No

Using the Internet now or in the past 6 months?

Located in the Lower Mainland local dialing area?

Incorporated as a non-profit society? (Number: ______________)

Registered as a charity? (Number: ______________)

An amateur athletic association? (Number: ______________)

In need of a computer? (New $515 + taxes/Refurbished $ _____)

Have a voluntary board of directors? (Attach list)

Operate democratically? (Attach minutes of General Meeting)

Have revenues of less than $500,000? (Attach Statements)