Flip Video Spotlight Program Application

1. Submit this application. Please review our guidelines.

2. Flip Video Spotlight reviews the application and determines eligibility.

3. Approved organizations receive an email about Spotlight Kit distribution.

Pure Digital Technologies, Inc. reserves the right to make all determinations regarding eligibility for participation and continuing participation in its sole discretion and to amend these requirements at any time and for any reason. All use of this web site will be subject to the Terms of Use and Privacy Policy for this web site and all purchases under the Program will additionally be subject to the Terms of Purchase.

Organization Information

My organization has 501(c)(3) status:	no yes

Organization Name:

Organization Description (no more than 2 sentences please):

Organization Type:

Website:

Mailing Address:

City:

State:

Zip Code:

Phone Number:

Federal Tax ID (XX-XXXXXXX):

Putting Video to Work

How will video contribute to your organization's goals?

In an ideal world, how many camcorders could your organization use this year ?

How many camcorders could your organization pay for ?

Does your organization post video online ?	no yes

If yes, please describe where Ex: your own website, Youtube, Myspace, The Hub

Do you accept online donations	no yes

Contact information

CEO/President/Executive Director:

Email:

Organization Contact Person:

Title:

Email Address:

Phone Number: