Funding request form for Group or Individual

Individual's name *

Group name and names and contacts of individuals from Memramcook who are part of the group *

Mailing address *

Telephone (home) *

Telephone (work)

Fax

Email *

Have you previously received financial assistance from the Village de Memramcook? *

Yes

If yes, please elaborate

Will you be participating in a national or international activity or event? *

Will you be participating in any activity or event other than national or international? *

Provide a brief description of the event or activity *

What are your current sources of funding and what amounts are you receiving? *

What type of support are you requesting from the Village de Memramcook? (Check the appropriate category) *

Financing

Installations

Services

Amount requested *

If the Village de Memramcook allocates a donation or sponshorship, I acknowledge that I or my group will respect the terms established by the village.

Required Documents

EACH REQUEST MUST BE ACCOMPANIED BY THE FOLLOWING (SEND BY EMAIL TO This email address is being protected from spambots. You need JavaScript enabled to view it. OR BY MAIL TO 540 CENTRALE STREET, MEMRAMCOOK, E4K3S6) : budget forecasts for the activity, the list of committee members or group and a letter of support from an individual or group sponsor.

Name