Just one lead from you might be the key to help get us funded, a contact name, an email and a company (or state "is individual" if not a company) is all that is needed.
Only the first three fields are required in the form, but please try to supply all the details you can, it will improve our chances of getting a communication going with the lead.
Your support in this small way will be a huge help and will be greatly appreciated as we really do need the assistance you can give.