The Transology Association Inc.
York Office for Transgender Affairs and Homeless Services
A 501(C)(3) Non Profit Association, (Public Charity)

Registration short form to Participate in the Food, Meals and Assistance Program
for the Homeless Community in York, Pennsylvania

This program is designed to help the Homeless by Companies and Businesses Donating their Product and/or Services to the program instead of cash donations. The products or services donated would have a total cash value of  your product or services. Vouchers would be processed that have a cash face value of $25.00 to $50.00 that would be given to Homeless Individuals or Families who would in return use those vouchers to purchase the product or services your business donated up to the cash value of your donations. Vouchers will never exceed the total amount of your donated product or service monetary value..

Business, Company or Store Name

Phone #                                             ,      E-mail Address:

Contact Name:

Please give a short description of your Business, Company or Store. ... Also let us know if you
will you be using your store vouchers for the program or Vouchers provided by The Transology Association

Donation Description as in ... Groceries, type of service: (Transportation, Counseling,
etc., Miscellaneous Product, clothing etc... use back of form if needed.

Total Monetary value of product or services donated.

How often would your donations continue: One time donation,                  Monthly ,
Once a Year on anniversary date of application,

Participants can withdraw from the program at any time without reason without penalty.

Date:                                                 This will be your anniversary date if a once a year donation:

I have reviewed the Rules and Regulations of the program and agree to participate in the program by signing this form as the Authorized Individual to provide donations to the program.

Signature of Authorized Individual
By typing your name  in the signature space you are signing electronically, Your electronic signature is binding

Transology Association Agent