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REQUEST FOR EXEMPTION FROM PAYMENT OF FEE

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REQUEST FOR EXEMPTION FROM PAYMENT OF FEE Powered By Docstoc
					                                             Shire of Augusta-Margaret River
                                                  PO Box 61 Margaret River WA 6285
                                                    Ph. 9780 5255 Fx. 9757 2512


                                             REQUEST FOR EXEMPTION
                                              FROM PAYMENT OF FEE




FEE TYPE (Please tick applicable):

  EVENT FEES             TEMPORARY FOOD PERMIT FEE                 BANNER FEE


APPLICANT NAME:              _______________________________________________________

ORGANISATION:                _______________________________________________________

POSTAL ADDRESS:              _______________________________________________________

APPLICANT’S PHONE NO:        ___________________________ FAX NO:____________________

TYPE OF ACTIVITY/EVENT:      _______________________________________________________


LOCATION OF ACTIVITY/EVENT:          ________________________________________________

DATE OF EVENT:                       ________________________________________________



TYPE OF ORGANISATION (tick one):

    COMMUNITY GROUP/CHARITY/NON-PROFIT ORGANISATION (UNINCORPORATED)
    NON-PROFIT COMMUNITY SERVICE ORGANISATION
    OTHER


WILL THE EVENT/ACTIVITY RESULT IN ANY PERSONAL GAIN OR REWARD EITHER
DIRECTLY OR INDIRECTLY TO THE APPLICANT?
   YES     NO


ARE ALL WORKERS ASSOCIATED WITH THE EVENT/ACTIVITY WORKING IN A VOLUNTARY
CAPACITY (UNPAID)?
  YES      NO

REASON FOR REQUEST:


_________________________________________________________________________________


_________________________________________________________________________________




APPLICANT’S SIGNATURE: __________________________ DATE:_________________________

				
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posted:4/19/2010
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Description: REQUEST FOR EXEMPTION FROM PAYMENT OF FEE