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Equipment Request
Equipment Request
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" indicates required fields
Date recieved
*
MM slash DD slash YYYY
Contact Details
First Name
Last Name
Your Club
*
Your Club
Ballarat
Barwon
Bendigo
Dandenong Casey
Echuca Campaspe
Melbourne Eastern Ranges
Melbourne Inner East
Melbourne North
Melbourne Southern
Melbourne West
Ovens Murray
Westernport
SOV State Committee
Other
Position in Club
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Untitled
Phone
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Email
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Request Details
Detail of equipment required and applicable sport program
List
Shipping/Delivery Costs
Total Cost for this request
Price:
$ 0.00
Has your club applied for funding in the past?
Yes
No
Previous Equipment Requests in the last 12 months
Please include detail of previous equipment requests in the last 12 months
Total Value of Previous Requests
How much are athletes contributing towards their attendance at this event? (if applicable)
What funds are being provided by the NDIS for athlete attendance?
What is the club contribution towards the total costs of equipment / event attendance?
Balance remaining for which you are applying for a grant from the LETR?
Additional Information
Additional Information that may assist
Please include any other relevant details that may support your request
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Quotes & supporting documentation
Please attach any relevant quotes or supporting documentation here
Max. file size: 29 MB.
Quotes & supporting documentation
Please attach any relevant quotes or supporting documentation here
Drop files here or
Select files
Max. file size: 29 MB, Max. files: 5.
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Club Bank Details
LETR will only reimburse to Special Olympics Club bank accounts
Club Bank Details
LETR will only reimburse to Special Olympics Club bank accounts
Account Name
BSB
Hidden
Number
18959
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