New Application

First name *

Last name *

Name of team or club (if applicable)

Email *

Contact phone number *

Sport

Street address

Address Line 1 *

Address Line 2

City *

Region

Postcode *

Country *

Postal address

Address Line 1 *

Address Line 2

City *

Region

Postcode *

Country *

Contact details of two people in your organisation

First name *

Last name *

Phone *

Address Line 1 *

Address Line 2

City *

Region

Postcode *

Country *

First name *

Last name *

Phone *

Address Line 1 *

Address Line 2

City *

Region

Postcode *

Country *

Is your team/club affiliated to a Wellington Association?

Is your team/club affiliated to a New Zealand Association?

Please provide details of your membership

Seniors

Juniors

Social

TOTAL

Please give full details of the proposed use of funds *

Please attach any supporting documents or files

docx, pdf, jpeg, png

Add another file

How will Eastern Suburbs Sports Trust be recognised by the individual, team or club? *

Full project costs (please note the cost of displaying the Eastern Suburbs Sports Trust logo is the responsibility of the applicant)

Project item	Cost

Add item

How do you intend to finance this project

The Trust views favourably applicant's that display they are attempting to raise some of the funding themselves.

Sponsorship

User fees

Fundraising

Other

Please detail here

Total amount requested in application

Project start date *

Project end date *

Are you applying to any other organisations for funding to assist with the costs of this project?

Have you received funds from the Eastern Suburbs Sports Trust in the past six months / year?

I hereby declare that the information supplied on this application is true and correct to the best of my knowledge