Charity and Raffle Quilts

Affiliated Group Name
Number of Members in Group
Contact Name
Contact Email Address
Contact Phone Number

Project

On behalf of the above Affiliated Group, I wish to apply for assistance from Queensland Quilters Inc for the following project

Charity Quilt
Raffle Quilt
In Support of

Funds Required

Maximum $250

Items to be Purchased

Item 1
Amount 1 $
Item 2
Amount 2 $
Item 3
Amount 3 $
Total Amount

Bank Account Details

Funds will be transferred to this Bank Account, if approved

Account Name
BSB
Account Number

Rationale

Please provide a brief explanation as to why you are applying for this assistance (max 100 words)

Confirmation

I acknowledge that

The Affiliated Group is currently a financial member of Queensland Quilters Inc and has been a member for the past 3 years
The maximum amount that will be granted is $250
The assistance is not ongoing and must be applied for in the year it is required
There is no guarantee that by applying for assistance it will be granted
The assistance provided by Queensland Quilters Inc will be acknowledged in any associated publicity