Stix n Pix Sponsorship Support Application (Stix n Pix)

Stix n Pix Sponsorship Support Application

Stix n Pix is offering the opportunity for funding for up to 5,000.00 for either an individual or group who will enroll and/or run program(s) for Norfolk youth in either music of hockey. Existing programs can apply along with new programs. Please complete Application - Submit Form at end, email confirmation will be sent to applicant. Any questions please contact Elaine Thomas - [email protected]

Applicant Information

Please complete section - any questions contact Elaine Thomas - [email protected]

Applicants Name^*

Required

Full name of person or Group

Contact Name

for a Group Application

Applicant Address^*

Required

Applicant City/Town^*

Required

Applicant Postal Code^*

Required

Applicant Phone Number^*

Required

Example: ###-###-####

Applicant Cell Phone Number^*

Required

Example: ###-###-####

Applicant Email address^*

Required

confirmation of application received will go to this email address.

Child's Name

if application is for a Child

Information on reason for applying

Please complete section

Did your child Participate in First Shift Program

YESNO

provided by Norfolk County & Stix n Pix

Nature of Funding ^*

Required

e.g. equipment, registration, team wear, financial please provide details

Total Cost of Equipment requested^*

Required

e.g. sport, music specific equipment

Amount (or approximate cost) of funding support requested^*

Required

Please provide a brief story outlining how this need came to be.^*

Required

Yes, I am willing to assist Stix ‘n’ Pix in its ongoing fundraising activities in support of grassroots hockey participation.

Yes I will

Yes, I am willing to submit photos and a descriptive write up of my child’s participation in the sponsored activity for use on the Stix ‘n’ Pix website.

I agree to the terms and conditions stated above

**Note: Additional information may be required depending on the amount of support being requested.

I agree to provide additional information if required^*

By clicking on the Submit Form button - your are acknowledging that you are the Applicant for completing this form, and it will be recognized by Stix n Pix as your signature.

I agree to the terms and conditions stated above^*

Stix n Pix Sponsorship Support Application (Stix n Pix)

Applicant Information

Information on reason for applying

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