Application to
Waive Not-for-Profit Membership Fee*
for Waynet, Inc.

This application is for not-for-profit, 501 (c) 3 organizations only. Please fill out the application. In addition, you must send:
	a copy of your IRS Letter of Determination
	a copy of your organization's yearly balance sheet
to Waynet, Inc. Attn: Jane Holman 50 North Fifth Street Richmond, IN 47374

Please provide the following contact information: (Red Fields are Required)
First name
Last name
Title
Organization	(required)
Street address of organization
Address (cont.)
City
State/Province
Zip/Postal code
Organization Phone
Contact's Phone	(required)
Organization E-mail
Organization's URL	(Example: WayNet's URL is http://www.waynet.org)
How does your organization serve Wayne County?

Describe the source(s) of your organization's funding.

You agree that you have read and consent to abide by the Terms of Service Policy.