Community Partnership Program Application

What round of funding is being applied for? *

Summary details of organisation:

Legal / registered name * company name

ABN * 12 345 678 910

Donation / sponsorship name *

Contact person * First and Last Name

Position / title *

Phone * 0400 000 000

Email * [email protected]

Physical address 123 Street Name Suburb, State, Postcode

Type of organisation *

Is your organisation GST registered? *

yes

Has your organisation been granted ‘deductable gift recipient’ status? *

yes

Please provide a brief summary of how your organisation will use the grant ? (max 1000 characters)

Approximately how many people will benefit from the grant? *

Declaration:

I certify that all the information provided in this application is current and correct and I give Bowen Rail Company permission to contact any relevant person or organisation in the processing of this application. I acknowledge and agree that if I am successful I will: *

Accept and support as awarded

Allow information about the initiative to be used by BRC for external communication and promotion purposes

Use BRC’s logo and/or display materials on sponsorship or event materials as agreed.

Community

Community Partnership Program Application

Summary details of organisation:

Declaration:

Supplier Registration of Interest