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2. City of Coquitlam Nonprofit Directory Listing Application

   Thank you for your interest in being listed in the City of Coquitlam Nonprofit Directory. Please fill out all the following fields to be considered for the directory. Note that City staff will be reviewing all applications prior to be posted in the directory. An application submission does not guarantee a listing in the directory. 

   Recognizing the value that non-profit organizations bring to our community, the City has created an online directory to be hosted on the City’s website available to non-profit organizations that provide services to the residents of Coquitlam.  All requests to be listed in the directory are subject to review by the City and the City reserves the right to refuse to list or to remove an organization, including any organization that promotes discriminatory or illegal conduct or views. 

   This directory is provided as a public service.  The accuracy of the content is the sole responsibility of the submitter.  The City of Coquitlam accepts no responsibility for the information contained in any listing approved for posting in the community directory or any claim or loss caused by the posting of incorrect or inappropriate information.

4. Organization Name*
6. Contact Person Name*

   Please include first and last name. The contact person name will not be published in the directory, it is just for the directory organizers to get in touch.

8. Address 1*
10. Address 2
12. City*
13. Province*
14. Postal Code*
16. Phone - Number*
17. Fax - Number
19. Email Address*
21. Category*

    Please check which category(ies) apply to your organization.

    1. Adult Recreation Clubs and Interest Groups
    2. Amateur Sport Association
    3. Arts, Culture and Festivals
    4. Environment Associations and Garden Club
    5. Family/Community Services and Support Organization
    6. Health and Safety

    1. Neighbourhood Association
    2. Religious Organization
    3. Seniors Services
    4. Service Clubs and Charitable Foundation
    5. Youth Organizations, Groups and Club
23. Link (web address) (http:// required) *
25. Description*
27. Privacy Information

    Please note the information being collected is considered contact information and thus is not subject to the Privacy Act and will be released on the City of Coquitlam website.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field