WHITIANGA LIONS CLUB INC
P.O. Box 157 Whitianga 35 10
Secretary Kevin Robinson
Email: kevie@xtra.co.nz
Name of applicant…………………………………Date…………………
Occupation…………………………………………………………………Address…………………………………………………………………….……………………......................................................................................
Telephone………………………………Email…………………………………………………………..
Support is requested for? Attach full details
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What is the name of the Project Orgainiser or Sponsor?.........................................................
What is the total cost of your contribution? $.......................................................
How much has been raised by you personally? $........................................
How was this achieved?
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What extended family support is available?..................................................
Who else has been approached for funds or support and what, if any, response has been achieved?
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What is the start time of your project or by when is funding required?
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If your project is oversubscribed what will you do with the surplus funds?
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The applicant agrees that:
Should the project not proceed funds will be returned to this Lions Club.
Relevant information may be requested from a third party.
If the project proceeds the applicant will address the Lion’s business meeting to share the experience.
Please note that If a donation is made by this Club to the organisation sponsoring the event or activity and you decide not to take part, all monies given must be refunded back to the Whitianga Lions Club.
Signed……………………………………………………………………
Designation………………………………………………………………
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