Application Form

Your Organisation's Details

Are you a:

Name of your Organisation:

Area of Interests:

Description Code:

Organisation Contact Details:	Phone: Email Address Web Address Street Address PO Box Address Post Code - State Country	include area code

*Contact Person:* (for enquiries relating to your request)	Title Given Name Surname Position Held Phone (Bus Hrs) E-Mail

*Organisational Details*	Do you have a Deductable Gift Receipeant Endorsement (DGR)	YES NO
	Date of DGR
	Do you have a Income Tax Exempt Charity Endorsement (ITEC)	YES NO
	Date of ITEC

*Brief History of your Organisation:*

Numerical Membership:

Mission:

Brief Description of the Services you provide:

Description of Project(s) for which you are Fundraising. (Include timelines and amounts to be raised)

*N.B. If you are fundraising for more than one project, submit separate descriptors:*

*Details of Fundraising undertaken in the past 3 years:*

Describe the management and committee structures that are in place to assist you in undertaking your fundraising:

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