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    » about the charity » who is eligible » become involved » apply online

Lions Minesite Recycling Charity

Application Form

Please complete this form and click "Submit". Your request will automatically be sent to our Committee for review. You will also receive a confirmation email that you can reply to and attach any additional relevant documentation.

Fields marked with a '*' are required.


Name*
Email*
Mailing Address*
City*
Contact No. (Work)*
Contact No. (Mobile)
Organisation Name*
Charity/Event Information*
Purpose of Organisation*
Event/Cause Description*
Event/Cause Name*
Donation Requested*
Is the organisation registered for GST? Yes      No
Contribution Deadline*
Have you previously requested charitable assistance from us? Yes      No
If yes, please provide background information: