Jump START Your Nonprofit Registration Form (Registration ends at 5:00 p.m. on Friday, October 11, 2013)
*Name of nonprofit organization:
*Contact's First Name:
*Contact's Last Name
*E-mail address:
*Contact telephone #: ()

*Zip code:
Facebook page: example: www.facebook.com/modernofficemethods
Twitter: example: @Modern_Office
*Organization is 501(c)(3) status?
(Eligible only for 501(c)(3) status)
*No. of employees:
*No. of volunteers:
*Communities served:
*How many people does your organization serve?
*Please describe the organization and the charitable work it does.
*What is your organization's mission?
*In 200 words or less, please tell us why your organization deserves the Office Technology Makeover.
*What do you think MOM can do to Jump START your office efficiency? (Please note: prizes are limited to black/white copiers, color copiers, fax equipment, multifunction systems [copy/print/scan/fax] and document management systems.)
*How did you hear about the contest?
If a Modern Office Methods Employee or Document Solutions Employee told you about this contest, please let us know who:
*I have read and agreed to the rules of the contest, and our organization has a physical address in one of the 55 Ohio, Northern Kentucky or Southeastern Indiana counties listed in the Official Rules.

*Required Fields
Copyright 2013 MOM. All Rights Reserved.