Noche Mexicana Fundraiser Request Form

Thanks for your request. We'll be in touch soon!

Required fields are marked with an asterisk and are highlighted in red.

Date of Event (Monday through Wednesday)
1st Choice *	2nd Choice	3rd Choice

Margaritas Location *

--Select-- 350 Roberts Street, East Hartford, CT12 Water Street, Mystic, CT725 Cochituate Rd, Framingham, MA438 Bedford St, Lexington, MA75 Station Landing, Medford, MA85 American Legion Highway, Revere, MA211 Moody Street, Waltham, MA765 Bridge Street, Weymouth, MA180 Center Street, Auburn, ME390 Western Avenue, Augusta, ME15 Mill Street, Orono, ME11 Brown Street, Portland, ME242 St. John Street, Portland, ME1 Bicentennial Square, Concord, NH23 Members Way, Dover, NH93 Portsmouth Avenue, Exeter, NH77 Main Street, Keene, NH18 Centerra Parkway, Lebanon, NH1037 Elm Street, Manchester, NH1 Nashua Drive, Nashua, NH775 Lafayette Road, Portsmouth, NH1 Keewaydin Drive, Salem, NH372 West Mt. Pleasant Ave., Livingston, NJ

Organization
Name *	Address *

City *	State *	Zip Code *

Contact Information
Name *	Email *	Phone *
Please write a brief summary describing your organization or effort. You may include a brief history, your purpose, your goals, and a listing of the different activities that you have chosen to go along with your benefit night (i.e. silent auctions, raffles etc). Place an emphasis on what you will be doing with the proceeds from your fund-raising efforts in the community. We will be providing this information to our staff so that they may be able to informatively discuss your organization before and during your benefit. *

Is this a 501 (c) 3 Organization? *   Yes No

Please be prepared to send us a copy of your 501 c (3) Certificate and W-9 Form.