District Club Support Request Form

The District is offering $10 per member to each Club to be applied toward programs or membership development. Pease complete this form to request your Club’s allocation.

Put Unity Back Into Community

Club Name(Required)

Club Treasurer/Contact Person Name(Required)

Email(Required)

Phone(Required)

Club Information

Current Membership Total(Required)

as of Date?(Required)

Total Support Amount ($10 Per Member)

Intended Use of Funds(Required)

Membership Development

Club Program Support

Club Fundraising Project

Other

You can Check one or More. This must be approved by the Club's Board before submitting.

Brief Description of How Funds Will Be Used:(Required)

Club President(Required)

CAPTCHA