Moment Giving Guide Submission Form

Please use the following form to place your entry.

Please enter all information for our records:
Contact First Name
Contact Last Name
Street Address 1
Street Address 2
City
State
ZIP Code
E-Mail

Please enter your Giving Guide submission below (this is what will be posted):
Program Title
Organization
Program Description	(Maximum characters: 1000—approximately 150 words) You have characters left.
Contact Name
Contact Phone
Contact Fax
Contact Email
Contact Website
Contact Postal Address



	Note: Please contact marketing@momentmag.com for more information. For images, please select either a photo or logo, sized approximately 1.5" x 1.5" at 300 dpi. Please keep in mind that because the image will run small, details such as faces in a large group shot may not be recognizable.