Select your centre*

Title:

First Name:*

Last Name:*

Company:

Address 1:*

Address 2:

City/Town:*

County:*

Post Code:*

Country:
Email Address:*

Mobile Number:*

Phone Number:

Date of Birth:*

Parent email address:*

 
Gender:
Fund amount required*

Name of club/group*

Activity Start Date (if applicable)
Activity End Date (if applicable)
Amount and Source of Match Funding already secured

Please provide supporting detail for the project that requires funding*

Please describe how your activity may improve quality of life or impact on the wider community*

Have you applied before?*

Select how you will upload any supporting documentation*

Attach your supporting documentation here
Attach your supporting documentation here
I confirm the information I have provided is accurate*
I confirm that I am willing to participate in any promotional and marketing activities to raise the profile of my project or fund allocated (if successful).*
I confirm I am willing to complete a Case Study with my Local Centre Manager and for this to be shared on your website and social media.*
Please add a photo of your club (ideally with participants) or individual photo if relevant to the application*
Tick below to receive other promotional offers from Legacy Leisure*

 
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