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?

How did you hear about The Ripple Effect - Community Events Support program? * Website
Facebook
Instagram
Google
E-News
Newspaper
Word of mouth
Wannon Water employee
Other

If other, please specify

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