Application Form

First Name *

Last Name *

Email *

Phone Number *

Name of team or club (if applicable)

Sport

Residential Address

Street Address *

City *

Region

Postcode *

Country *

Postal Address

Street Address *

City *

Region

Postcode *

Country *

Contact details of two people in your organisation

Organisation Contact 1

First Name *

Last Name *

Phone Number *

Street Address *

City *

Region

Postcode *

Country *

Organisation Contact 2

First Name *

Last Name *

Phone Number *

Street Address *

City *

Region

Postcode *

Country *

Is your team/club affiliated to a Wellington Association?

Is your team/club affiliated to a New Zealand Association?

Please provide details of your membership

Seniors

Juniors

Social

TOTAL

Funding and Recognition

Please give full details of the proposed use of funds *

Please attach any supporting documents or files

docx, pdf, jpeg, png

How will Eastern Suburbs Sports Trust be recognised by the individual, team or club? *

Full project costs (please note the cost of displaying the Eastern Suburbs Sports Trust logo is the responsibility of the applicant)

Please enter items and costs. New fields will appear as items are entered. Max 10 items.

Item 1: name

Item 1: cost

Item 2: name

Item 2: cost

Item 3: name

Item 3: cost

Item 4: name

Item 4: cost

Item 5: name

Item 5: cost

Item 6: name

Item 6: cost

Item 7: name

Item 7: cost

Item 8: name

Item 8: cost

Item 9: name

Item 9: cost

Item 10: name

Item 10: cost

How do you intend to finance this project

The Trust views favourably applicant's that display they are attempting to raise some of the funding themselves.

Sponsorship

User fees

Fundraising

Other

Please detail here

Total amount requested in application

Project Dates

Project start date *

Project end date *

Declarations

Are you applying to any other organisations for funding to assist with the costs of this project?

Have you received funds from the Eastern Suburbs Sports Trust in the past six months / year?

I hereby declare that the information supplied on this application is true and correct to the best of my knowledge *