Beaumont & District Lions Club
Box 3015 Beaumont Alberta Canada T4X 1K8
Phone Fax Email
Request For Information
We have received your request for funding and would ask that the following information be supplied. This information is a great deal of help in aiding our decision process. This information will not be shared with any other party and is treated in the strictest of confidence. We do not intend this request to be an attempt to control your project but as an aid in our decision process.
Date
Name of Organization or Individual
Address
Postal Code
Phone Fax Email
Is your Organization a Registered Charitable Organization?
Registration #
President
Phone Fax Email
Secretary
Phone Fax Email
(1) Briefly state the purpose of your request.
(2) What is the amount of your request?
(3) Please indicate other sources which you are requesting funding from.
(4) What is your organization\individual doing to raise some of the funds required for this project?
(5) How will your organization\individual use the funds if:
a) the goal is not reached?
b) the project does not proceed?
c) excess funds are received?
(6) Would you like to have the opportunity to report on your project at a later date?
Please attach one copy of the following information:
your annual budget and the budget for this project.
your most recent financial statement and your current financial position.
any other information you feel is of value to our Lions Club in helping us to help you.
THIS DOCUMENT IS AN INFORMATION SHEET ONLY, AND THE APPLICANT(S) AGREE THAT THE BEAUMONT AND DISTRICT LIONS CLUB ACT SOLELY AS A FUNDING AGENT. THE APPLICANT(S) INDEMNIFIES THE BEAUMONT AND DISTRICT LIONS CLUB WITHOUT LIMITATION FOR THE USE OF
ANY INFORMATION SUBMITTED BY ANY APPLICANT(S), THE GROUP AND OR INDIVIDUAL THAT ACCEPTS, AND OR APPLIES FOR FUNDS FROM THE BEAUMONT AND DISTRICT LIONS CLUB AGREE BOTH JOINTLY AND SEVERALLY, TO INDEMNIFY AND SAVE HARMLESS THE BEAUMONT AND DISTRICT LIONS CLUB, ITS OFFICERS, DIRECTORS AND MEMBERS, FROM ANY AND ALL ACTIONS, CAUSES OF ACTION, SUITS, DAMAGES, COSTS, AND LOSSES OF ANY NATURE, ARISING FROM THE USE OF THE FUNDS, OR FROM ANY OFFER OF MONIES BY THE BEAUMONT AND DISTRICT LIONS CLUB AND OR REFUSAL OF MONIES TO ANY APPLICANT(S), FOR ANY REASON WHATSOEVER. THE BEAUMONT AND DISTRICT LIONS CLUB, CAN, WITHOUT NOTICE OR LIABILITY, REVOKE ANY OFFER TO FUND AT ANY TIME AT THE SOLE DISCRETION OF THE CLUB.
Applicant Name Signature
Date
We would ask that you complete and return this form in the next week as we meet only twice a month on the second and fourth Mondays and our decision process is dealt with at those times. We thank you for thinking of club in your time of need. Should you require further assistance please call our secretary
Date
Thank you for considering the Beaumont and District Lions Club for support for your project.
