Patronage Application

Organisation details:
Full name of organisation

Does you organisation trade under a different name?

Postal address

Organisation contact:
Contact name

Position

Phone (work)

Mobile

Email

Organisation information:
In what year was your organisation established?

What sort of legal entity is your organisation?

Is Vice Regal Patronage being sought on an ongoing continuous basis or for a one-off event?

Which sector best describes you organisation?

In no more than 100 words, please describe the mission/purpose of your organisation OR please provide copy of the current Strategic Plan for your organisation

What is the reach/rank of your organisation?

Does your organisation employ staff?

How many members are on your Board of Directors/Managing Committee?

If your organisation has members, how many does it currently have?

What are your organisation's principal source of funding?

If you are seeking to renew Vice Regal Patronage please advise how long you have previously had such patronage.

Does your organisation currently have any other Patrons?

Please describe how active your organisation is in the community.

Please upload a formal cover letter including a current list of office bearers (indicating the principal point of contact) and a short background history of the organisation from its inception to present day.

Organisation declaration:
I confirm that the information provided is true and accurate. I understand that any incorrect or incomplete information may impact on the decision by Government House Western Australia to recommend Vice Regal support to my organisation.

Name

Position

Date

Note: this information is sought for the sole use of Government House Western Australia and will not be disclosed to a third party without the consent of the originating body

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