Pemberton and District Initiative Fund Fee Waiver Application Form

Please complete this application form and submit along with any additional information that may be of assistance to the SLRD for Fee Waiver Funding. Incomplete applications will not be accepted.

Application packages may be submitted by e-mail, mail or fax. Alternatively, applications can be submitted online through this digital application form.

The Squamish-Lillooet Regional District is committed to respecting and protecting the privacy of our website visitors. For more information, visit the SLRD Privacy Policy and Collection of Personal Information.

Organization Information

Application Date

Applicant Name

Registered Tax Charity # or Society Registration # (if applicable)

Date of last filing of annual report/bylaws with the provincial government (if applicable)

Applicant/Primary Contact Name

Primary Contact Phone #

Primary/Organization Mailing Address:

Address

Address 2

City/Town

Province

Postal Code

Primary Contact Email Address

Are all corporate filings with the provincial government up to date?

Yes

Applicant's Mission Statement or Key Goals

Details of Funding Request

1. Please identify the funding stream

Funding Stream

Arts, Culture and Recreation stream

Economic Development stream

2. Total fee waiver requested $

3. Total budget of the project, program or activity: $

4. Name of project, program or activity needing support. Provide a description and identify how it will benefit, strengthen and enhance the well-being of the residents of the Village of Pemberton and SLRD Electoral Area C.

5. Please include the Pemberton and District Community Centre rental request form with your application: https://www.pemberton.ca/municipal-services/recreation-services/pdcc

Anticipated Start Date:

Anticipated End Date:

Detailed Project Budget Including:

• Detailed Cost Estimates
• Sources of Confirmed Revenue
• Sources of Unconfirmed Revenue
• Sources of Donations
• Any other Sources of Revenue

Detailed Project Budget

One file only.
512 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Most Recent Financial Statements (as applicable)

Society Documentation (e.g. current registration, bylaws, etc.)

Letters of Support (as applicable)

Additional Documents

Agree

Agree to attend PVUS Meeting to Present In-Person (as applicable)

Agree

Agree to Provide Project Update and Final Reporting Requirements

Agree

I understand that checking this box constitutes a legal signature

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