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

Select the box that best describes your project *

Infrastructure equipment (eg. goal posts, padding, electronic scoreboards)

Storage

Other

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

In one paragraph, explain how the need for this project was established and how it will benefit the Region/Association/Club *

Upload your project funding template

If funding approved is less than funding requested for this project, or the project is more expensive than indicated in this budget, where will the extra funds be sourced from? *

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 *

	Membership number
2017
2018
2019
2020

Has the applicant participated in the 2021 Netball Community Raffle *

Yes

No

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 *