Application to Tim Gates Foundation for Funding

Is the application for an Individual or Group?*
- Individual
- Group
Name of Individual*
First Last
Fairhaven Member Since: (e.g. 2016/2017 Season)*
Name of Group: (e.g. Nippers/Sports/Lifesaving Ops)*
Contact Email:*
Contact Number*
Purpose of Funding*
Amount Requested:*
Total Cost/ Other Contributions?
Further Details or Equipment Quotes etc:
How will FSLSC benefit and how does Funding/purchase fit in with the aims of the Tim Gates Foundation?
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Name
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Cnr Great Ocean Road and Yarringa Road
Melway Ref: 511 C10

Postal Address
PO Box 221
Airey's Inlet
VIC 3231

All donations will be used to to support the Fairhaven SLSC and its members.

More information can be in our Aims section.