We Believe Alliance
World Record Application Form

World Record Recognition Program Information

Name of Applicant (Organization):

Address:

Contact Name:

Title of Contact:
Phone Number:

###-###-####
Email Address:

e.g: johnsmith@gmail.com

World Record Attempt Description:

Community Organization that will be the beneficiary of the world record attempt:
Description of the organization:
Name:
Address:
Phone Number:

###-###-####
Email Address:

e.g: johnsmith@gmail.com
Contact Name:
Title of Contact:

Date when the world record attempt will be made:
Start Date:
Finish Date:

Where will the world record attempt be made (City and State):

Name of Mayor and City: