Application for Travel Grant

First Members Application Details

Name*

First NameLast Name

E-mail

How would you like to be paid by DanceSport Nelson*

Direct to my Bank Account (Bank account to be supplied below)I would prefer a cheque (no cash will be given out)

Bank Account Number

Second Member Application Details

Please note: If some details are the same as the First Member, you can leave them blank.

Name*

First NameLast Name

E-mail

How would you like to be paid by DanceSport Nelson

Direct to my Bank Account (Bank account to be supplied below)I would prefer a cheque (no cash will be given out)

Bank Account Number

Please provide details of

Competition Attended*

Date of Competition*

DayMonthYear

Results Acheived*

Any other form of funding received for this competition*

Membership of any other Association*

Conditions:

1. Travel grants are made at the discretion of the committee and are subject to finance.
2. Applicants must be financial members at time of competition.
3. For Adult couples the application should be signed by one of the partnership. For Juvenile/Junior couples the application may be signed by a parent or guardian.
4. Currently a maximum of FIVE (5) travel grants may be applied for each financial year.
5. Applications must be submitted within ONE (1) month of the competition.

Declaration*

To the best of my knowledge, everything that is entered on this form is true and correct

Please submit this form.

Alternativelly, if you are posting your application, please forward to either:

Secretary / Treasurer, C/- 13 Ashcroft Place, Richmond, Nelson 7020

or

President, C/- 8 Holcroft Place, Stoke, Nelson 7011

Todays Date*

DayMonthYear

Enter the message as it's shown*

DANCESPORT NELSON
Application for Travel Grant
Name of Applicant/s: . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address for payment of grant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Please provide details of:
(i) Any other form of funding received for
this competition:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(ii) Membership of any other
Association:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(iii) Competition attended: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(iv) Date of Competition: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(v) Results achieved: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signed . . . . . . . . . . . . . . . . . . . . .
_____________________________________________________

Please forward all applications to:
The Secretary/Treasurer OR The President
Lindsay Bell Sandra Maxfield
784a Atawhai Dr 13 Ashbury Street
Nelson Nelson
Cheque No: Date: