To request a Donation, please complete this form:

* Required items

 

* First name:

* Last name:

* Your e-mail:

* Your phone number:

* Organization Name:

* Organization Address 1:

* Organization Address 2:

* Organization City:

* Organization State:

* Organization Zip:

Deadline for receiving donation:
(i.e. 09/12/2008)
* Current Relationship with KEEPRS:
Type of Donation Requested:
(i.e. monetary, product etc.) 

 * Please describe in detail the type of donation you are requesting:

 

 

 

 

Toll Free: 1-877-4KEEPRS
St. Cloud: 320-529-9585
Twin Cities: 651-288-5199