Community Engagement Program 2023
Expression of Interest
Organisation Details
Please tell us a bit about your organisation
Name of Organisation
*
Organisation ABN
*
Select your state
*
Please Select
Victoria
New South Wales
Queensland
South Australia
Western Australia
Tasmania
Australian Capital Territory
Northern Territory
Postal Address
*
Address Line 1
Address Line 2
City / Suburb
State / Territory
Postcode
Organisation Phone
*
Number of active members in the organisation
Please briefly tell us what your organisation does
*
You can include information about your services
Please outline your event idea for 2023, including potential event name, target audience, objectives, format, date (or at least month), potential venue/s, and fundraising mechanism/s
*
If you have already prepared a draft budget (estimated profit and loss) please upload the Excel spreadsheet here
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Representative Details
Representative Name (person completing this form)
*
First Name
Last Name
Representative Designation/Position
*
Representative Email
*
example@example.com
Representative Number
*
Please upload a copy of 1 of the following documents - Certificate of Incorporation (Inc. organisation) OR Certificate of Registration (company)
*
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I declare that:
*
I am duly authorised by the organisation to make this application on its behalf; and
Neither myself nor any of the current Directors or Office-bearers of the organisation have a criminal record
Please note: This form is an Expression of Interest (EOI). All submissions will be reviewed by the MHFA Board, and you will be contacted regarding the success or otherwise of your EOI.
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