Club Name*District Number*Name Of Organising Club OfficerOfficer’s Address Email Address*Home Phone*Mobile PhonePosition in clubClub will sponsor √ $950 $475 Name of Club MentorMobile PhoneEmailWe have sourced a student √*YesStudent’s application is attached √YesNoWe have not sourced a student & request the committee’s help √YESStudent’s Name if knownStudent’s EmailMobile PhoneHome PhoneStudent’s Address Name of student’s parent or guardianParent/guardian’s permission given √YESNoStudent has submitted an application √YesNoIf submitted — DateWe will pay $475 & partner Club nameName of Mentor in Partnering ClubMobileEmailOur club will assist in selling the extremely interesting books Casting Off Tradition about David Binks’ life knowing $17 from each book sold supports the program. Enter the NumberBook Money submittedDateWe will also support RYWELL sending an at-risk student on a five day voyage with a contribution of$150$300OrORRYWELL Money SubmittedDateThe above application approved by — President’s nameDate of AuthorisationSponsorship Money submittedDateOn completion of this online application form, tag & deposit your money into our bank A/c as below, then fill in the deposit date, tag and amount below on this sponsorship form and submit it. Note if you have requested the Committee’s help in sourcing a student and they are unable to do so to your satisfaction your money will be refunded in full Paid to Rotary Club of Glenelg Inc. One and All Account BSB 105-015 Account no 135188440 the amount of $ ………………….. on date …../…../….. tagged with club name(shortened if necessary) followed by One All e.g. “Gawler Lt 1All”SendThis field should be left blank
