McLaren Parade, Port Adelaide SA 5015


Club Officer's Address
Club will sponsor
We have sourced a student
Student's application attached
Parent/guardian’s permission given
Student has submitted an application
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We will pay $475 & partner Club name
Price: $40.00
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We will also support RYWELL sending an at-risk student on a five day voyage with a contribution of
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1. When this online form is completed, submit one copy.

2. Forward second copy as an Official Invoice to your Club Treasurer with a request for prompt payment Amount $ ………………….. Date submitted to the treasurer ……./…..../..…..

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3. Treasurer - pay by direct deposit tagged with club name (shortened if necessary) followed by “1All” (e.g. “Gawler Lt 1All”) to Bank SA BSB 105-029 Account Number 089 338 540

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 - Last day for payment 4 weeks before voyage commences

When you have completed this form, please check your email for a confirmation copy to be sent to you. Please then 'forward this email to your Treasurer.