Organization Name: ____________________________________________________
Address: ____________________________________________________
City:________________________ State: ____________ Zip:__________
The applicant organization is:
An Atheism/Freethought organization
Non-profit
Non-political
Listed in the current Freethought Directory
During calendar year 2005, the organization has:
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Application/Nomination submitted by:
Name: __________________________________________
Address: ________________________________________
City: __________________ State: ______ Zip: ________
Phone: _________________ Email: __________________
Mail To:
Community Cooperation Award
C/o Atheist Alliance International
PO Box 967
Diamond Springs, CA 95619