Brian Sellars Test

Participant Details

Is this an individual or group application? *

First Name *

Last Name *

Age at time of activity *

Your Organisation Name *

Age of oldest participant *

Email Address *

Contact Number *

Number and Street Address *

Post Code *

Type of activity *

Name of activity provider *

Tell us more about the activity *

Date of Activity *

Total cost of activity *

GBP

How much are you requesting? *

GBP

The trust can only fund up to 50% of the overall activity cost

Activity Provider Website *

Activity Provider Email Address *

Activity Provider Bank Account Name *

Activity Provider Bank Account Number *

Activity Provider Bank Sort Code *

Date Payment Due *

What benefits will you gain from participating in this activity? *

Details of Other Fund Raising Activities and/or Grant Aid Bodies approached: *

Full Name *

Email Address *

Contact Number *

Organisation Name *

How do you know this person? *