United We Stream Asia

INFORMATION CLUB / INSTITUTION
Venue / Club*
Name
Operator / Operating Company*
Legal form*
Ltd/pte ltd/Inc/etc.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Copy of commercial - / club register o.e.

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Venue's Logo

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Did someone apply for this club before?*

YesNo
Requested amount*
in Dollars (full dollars) (max.: rent (incl.fix electricity costs) per month + 20%)
Proof of rent amount (incl. fix electricity costs)*

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copy of rental contract or statement of account of last rental payment. Cancelof
I agree to send an invoice to Homeaway Agency pte Ltd. in order to receive fundings on the following activities:*

yesno
*cultural activities:

United We Stream live streaming

	1-5	6-10	11+
full years

	1-5	6-10	11+
full years

	< 10h/Week	10,1 - 30h/Week	30,1+h/Week
amount

ADDITIONAL INFORMATION ABOUT THE PRIORITY OF THE FOLLOWING TOPICS FOR YOUR VENUE
Inclusiveness

within the team, service, program etc.0/500
Diversity and gender equality

within the team, service, program etc.0/500
Education

within the team, service, program etc.0/500
Socio-cultural engagement

soli-/charity activities*0/500
Sustainability

ecological aspects0/500
Other cultural activities in your venue

0/500
Other information which should be provided with this request
program of the past month, planned program or any other info
Should be Empty: