This form is for new charities only, who have not participated with Birdies for Charity in prior years.

Charity sign-ups will be open through May 31, 2024 – register now to get started!

Please complete the form below to register your 501(c)(3) organization for the Birdies for Charity program. After submitting the form, it will be reviewed for approval. Upon acceptance, charities will receive an email confirming their enrollment and their unique Bird #.

• Charities must be publicly supported and recognized by the IRS as a 501(c)3 charitable organization
• Participating charities are required to be within the Quad Cities region (IA/IL) and surrounding communities at this time, within 125 miles

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Charity Name *

Please list your charity name as it should be shown on website and in our database.

EIN # *

Employer Identification Number

Number of People Served Annually *

Year Founded *

Mission Statement & Description of Organization *

Does your organization serve at least 51% diverse populations? *

• Yes
• No

What group(s) comprise 51% of people served by the program? *

• African American
• American Indian or Alaska Native
• Asian
• Hispanic, Latino or Spanish
• Native Hawaiian or Pacific Islander
• White
• Other
• N/A

Does your program focus on any of the groups identified below? *

• Persons with disabilities
• LGBTQIA+
• Veterans
• Women
• N/A

Contact Information

First Name *

Last Name *

Title of Contact Person *

Email Address *

Phone Number *

Address *

City *

State *

Zip Code *

Participation of charitable organizations will be reviewed based on the following criteria *

This form certifies that the charity agrees to comply with the rules and regulations of the Birdies for Charity program as stated in the official program rules. The Birdies for Charity program is intended to support charitable organizations, services, operations, and programs. It is not intended to be used for endowment or brick and mortar charitable purposes. Charitable contributions may not be part of a capital campaign and must come from a designated donor. This form also certifies that the charity has reviewed and understands the current year's Charity Reference Guide, including important updates for the 2023 year.

501(c)(3) status as recognized by the IRSWe are a schoolWe are a church/private organizationWe are a government organization

I verify that our organization is in either Iowa or Illinois AND located within 125 miles of Silvis, IL.

Please attach your 501(c)(3) determination letter from the IRS here. Only PDF files accepted

File name:

File size:

*