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Submitted on Jul 6, 2026 at 8:37 PM

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Organization Name^*

First Name^*

Last Name^*

Contact Phone Number^*

Your Email Address^*

Title

Address

Street address

Apartment, suite, etc.

Organization Phone Number^*

Fax Number

Organization Type^*

If Other, please identify organization status

Has this group participated in a Distillery FUNdraiser in the past?^*

How did you hear about our FUNdraising program?^*

Purpose of FUNdraiser^*

I would like to have a FUNdraiser in^*

At this Distillery Location^*

Henrietta

Rochester

Victor

Additional Notes

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