<h3 class="f3">Contact</h3>
<h5>*all fields required.</h5>
<div class="col-sm-5 col-md-6 col-xl-12">First Name
[text firstname]
</div>
<div class="col-sm-5 col-md-6 col-xl-12">Last Name
[text lastname]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Name of Organization/ Group
[text organitationname]
</div>
<div class="col-sm-12 col-md-12 col-xl-12">Phone*
<div>
[tel* telephone]
</div>

</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Email Address*
[email* email]
</div>
</br>
<div class="col-sm-5 col-md-6 col-xl-12">
Event Location
[text eventlocation]
</div>
<div class="col-sm-5 col-md-6 col-xl-12">Expected Attendance
[text attendance]

</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Event Date*
<div style="width: 100px; float: left;">&nbsp;&nbsp;&nbsp;
<label>Month</label>
[select menu-808   "Jan" "Feb" "March" "April" "May" "June" "July" "Aug" "Sep"  "Oct" "Nov" "Dec"]
</div>
<div style="width: 100px; float: left;">&nbsp;
<label>Day</label>
[select day   "1" "2"]
</div>
<div style="width: 100px; float: left;">&nbsp;
<label>year</label>
[select year  "2014" "2015" "2016"]
</div>
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Please tell us about your event and why GRBC should donate to your cause*
[textarea textarea-158 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">What type of donation are you seeking? (Swag bag for silent auction, meeting space or other donation.)
[textarea textarea-67 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Are you a tax-exempt 501(c)3 or 501(c)6 organization? (if yes, please include tax exempt number.)
[textarea textarea-772 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12" style="padding-bottom: 10px;">
[submit]
</div>
<div style="width: 100%;">* GRBC reserves the right to support our employees and their families. If you do see us present at any of the above events, chances are we're just making a small contribution to a cause or event involving one of our employees or they are choosing to support the cause themselves. Don't take offense.
</div>
[Donation Form]
[firstname] <wordpress@shopmobionline.com>
Hi  Admin, 

A Donation  Form Request  has been submitted with below details.

Name: [firstname] [lastname]

Phone Number: [telephone]

Organization Name : [organitationname]

Email Address: [email]
Event Location: [eventlocation]
Expected Attendance: [attendance]
Event Date: [day]/[menu-808]/[year]
About event:  [ textarea-158]
Type of donation: [textarea-67 ]
Are you a tax-exempt : [textarea-772]
mahesh@bosswebtech.com
Reply-To: [your-email]




[your-subject]
GRBC <wordpress@shopmobionline.com>
Message Body:
[your-message]

--
This e-mail was sent from a contact form on GRBC (http://shopmobionline.com/projects/GRB)
[your-email]
Reply-To: girjesh@bosswebtech.com



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