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TPW West Application
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1
. Contact Info
Contact Info
Name:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
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KY Kentucky
LA Louisiana
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MP Northern Mariana Islands
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PW Palau
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UT Utah
VT Vermont
VI Virgin Islands
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WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
Thank you for your interest in joining TPW West.
Please complete the information form below and be sure to submit your resume or biography to Glen Galaich (glen@tpwwest.org).
2
.
Please describe your reasons for wanting to be a member of TPW West and what you hope to gain from the workshop.
3
.
Please describe your current giving program and interest areas.
4
.
Beyond making grants, please describe your civic involvements, board service and volunteer work.