Organization

Preferred Official Language - None -EnglishFrançais

Name of Organization *required.

Name of Contact Person *required.

Address

Country - None -Canada

Address 1 *required.

Address 2

City *required.

Province *required. - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Postal code *required.

E-mail *required.

Telephone

Mobile

Short statement on the overarching purpose of your organization, its objectives, activities and future plans.

Year your organization was founded

Is your organization a national, regional, or local entity? - None -NationalRegionalLocal

Name(s) of current patron(s)

Year your organization was first granted Viceregal Patronage (if patronage was granted previously)

Identify any major projects or future events

What specific involvement by the Governor General do you seek?

How is your organization funded?

Does your organization receive corporate sponsorship? If so, from whom?

Reference(s)

Please provide the name and contact information of a local body, central government, or key authority in your sector of interest that will support this request for patronage.

Further comments in support of this application:

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