The Ripple Effect - Community Events Support form

Name of organisation *

Name of auspicing organisation if your organisation is not incorporated

ABN *

GST registered * Yes
No

Public liability Insurance * Yes
No

Description *

Please provide a brief description of your organisation, its mission, activities and capabilities

Area *

Where is your organisation based? What geographic area does it cover?

Contact name for this application *

Position *

Phone number *

Please provide the best number for you to be contacted on

Email address *

Event name *

Event description *

Event location *

Event date(s) *

Items requested - see the guidelines on the webpage for photos and descriptions * Choose Tap water bottles
Loan of Choose Tap water bottle refill stations (requires access to a drinking water tap)
Loan of 15-litre insulated water containers/dispensers
Loan of reusable plastic cups
Choose Tap paper cups
Prize packs in a buckets
Prize packs in a bag
Financial support
Other

Items requested - other

Amount of items requested *

Contributions from your group and others *

Outline the cash and in-kind contribution your organisation and/or any other sources for this event.

Community benefit *

Describe how the event will benefit the community, in relation to: regional prosperity; health and wellbeing; education, training and volunteering; and/or natural environment.

Scale of impact *

How many events? Which town(s)? How many local government areas? How many people?

Alignment with Wannon Water *

Describe how the project aligns with our mission to provide safe, reliable, innovative and sustainable water services and strengthen communities in south-west Victoria

Telling the story *

How will you tell the story of this event and acknowledge this support from Wannon Water? Is there opportunity for Wannon Water to promote our messages at this event?

I have read, understand and agree to Wannon Water's Ripple Effect Community Partnerships Guidelines *