Fields marked with an asterisk * are required. 1. Organization InformationName of Organization* Number of Members* How would you like to receive your invoice? (Check one)* Email Regular Mail Email invoice to:* Mailing Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code 2. Number of TicketsHow many tickets would you like?* There is a minimum of 200 tickets, and can be increased in increments of 50.Is your organization eligible for a GE Exempt rate? Yes, my organization is eligible for a GE Exempt rate. 3. Applicant InformationPlease provide 2 applicants who Zippy's may contact regarding your inquiry. Applicants must be over 18 years of age, and living in different households.A. Primary ApplicantPrimary Applicant Name* First Name Last Name Mailing Address* Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Phone*Alternative PhoneBusiness PhoneEmail Address* Employer* B. Secondary ApplicantSecondary Applicant Name* First Name Last Name Mailing Address* Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Phone*Alternative PhoneBusiness PhoneEmail Address* Employer* 4. OtherHow did you hear about our fundraising program?Please select oneFriends & FamilyTVRadioSocial MediaOtherOther* Area where tickets will be sold? (Check one)* Honolulu Windward Leeward Hilo Kahului ALL Purpose of Fundraising*CAPTCHA