Online Form - Minor Donations Program Application

Contact Information

This application is being made by a:*

Bank Details

If your application is successful, payment will be made by electronic funds transfer (EFT)

Your Application

Do you reside in the City of Busselton or in the case of an organisation/group/team are you based in the City of Busselton?*

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How will the City of Busselton be recognised as a sponsor? Please specify.*

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Please read the following Terms and Conditions:

  1. I am duly authorised by the applicant to make this application;
  2. The information provided above and attached is true and correct to the best of my knowledge;
  3. I shall promptly notify the City of Busselton in writing of any changes to the information contained in this application and attachments;
  4. Any funds granted by the City of Busselton will be used in the manner and on the conditions stated in this application;
  5. To the best of knowledge there will be no conflict of interest between the applicant and the City of Busselton arising from this application;
  6. The applicant shall not make any misleading public statement concerning this application;
  7. The applicant shall comply with all State and Commonwealth laws relevant to this application and any activity in connection thereto;
  8. The applicant indemnifies the City of Busselton and its officials and employees against any/all liabilities as a result of any action, suit, claim, demand or proceeding taken or made by any third party arising from or in connection with this application or any activity in relation thereto;
  9. Nothing in this application may be construed to make the applicant a partner, agent, employee or joint venture of the City of Busselton State; and
  10. The applicant shall not represent that the applicant or any of its members, employees or officials are the employees, agents, partners or joint ventures of the City of Busselton;
I agree to the Terms & Conditions listed above.*

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