EmailMe Form - Netball WA Community Facilities Fund (CFF)

APPLICANT DETAILS

Select what kind of entity you are *

Region Name *

Association Name *

Please type the name of your club below *

Facility Address *

Enter Postal Address if different from Facility Address

Details of Preferred Contact Person *

First Last

Enter the first and last name of your preferred contact person

Position *

Contact Number *

Email *

Does the Applicant have an ABN? *

Yes

No

If yes, please provide the ABN

Is the Applicant registered for GST? *

Yes

No

Is the Applicant Incorporated *

Yes

No

If yes, please provide the Applicants Incorporation number

PROJECT DETAILS

Describe the project the funds will go towards if you are successful *

Upload your project funding template

Do you share your facility with other sports/clubs? *

Yes

No

If yes, enter the names of the other sports/clubs below

Please enter the Applicants Membership numbers for the below years *

Has the applicant participated in the Netball Community Raffle *

Yes

No

Enter the number of raffle books sold by the Association, Club or Affiliated Clubs each year they have participated in the Netball Community Raffle

APPLICANT'S CERTIFICATION *

I certify that the information supplied is to the best of my knowledge, true and correct.

Name of person submitting application form *

First Last

Position of person submitting application form *