Test DP - Wonthaggi Workers Club

Community Support Application Form

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Organisation Name:*

ABN (if applicable):

Address*

Street Address City State / Province / Region ZIP / Postal Code

Contact Person:*

Position/Role*

Email*

Phone*

Website/Social Media (optional):

Briefly describe your organisation and its purpose (max 150 words):*

How many members/participants benefit from your organisation?*

Type of Support Requested (tick one or more):*

Major Grant (over $1,000)

Minor Grant (up to $1,000)

Venue Voucher (for raffles/fundraisers)

In-Kind support (catering, venue hire, equipment)

Describe the project, event or initiative requiring support:*

Amount or value of support requested:*

How will this contribution benefit the local community?*

How will Wonthaggi Workers Club be acknowledged for its support?*

Event or project date (if applicable):*

Signature*

Date Signed*