Application Form

Shane Love's Moore Community Grant

* Indicates required field

Name of Group *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Name of President *

First

Last

Email *

Phone Number *

Name of Secretary *

First

Last

Email *

Phone Number *

Please describe what your group or organisation does (purpose, activities, membership): *

What will the grant be used for: *

*Please indicate whether you are happy to have your group’s photo taken and be aware that this may be published in mainstream print or social media. *

Yes No

Disclaimer: Please be aware that the details you provide the Dandaragan CRC in this application process will be provided to Shane Love's Office, but not used by the Dandaragan CRC for any other purpose.

Submit

Dandaragan CRC

3468 Dandaragan Road
PO Box 8, Dandaragan WA 6507

P: 08 9651 4071 F:08 96514455
E: office@dandaragancrc.net.au

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The Dandaragan CRC is a member of the AWACRC Inc and a part of the Western Australian Community Resource Network.
The Western Australian Community Resource Network is a Royalties for Regions Initiative.