NCUCC

North Carolina 811 Center Funds Request Form
Many Local Utility Coordinating Committees invite excavators in their areas to attend educations seminars on Underground Damage Prevention and North Carolina 811. North Carolina 811 will help fund such events in an effort to encourage and help support local Utility Coordinating Committees.

Name of Utility Coordinating Committee

Date of Request

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Committee Chairperson

Chairperson's Phone Number

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Event Type:

Damage Prevention Awareness Breakfast

Damage Prevention Awareness Luncheon

Damage Prevention Awareness Dinner

Safety Tailgate Meeting

Other, Please Specify

Details of event type if you chose other

Event Sponsors

Event Date & Time

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DD

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YYYY

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MM

AM/PM

Event Location

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Number of Guests

Cost Per Person

Requested Fund Amount ($200 or less)

Check Payable To

First

Last

Mail Check To

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Person Requesting Funds

First

Last

Phone Number

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Email Address