Submit the following information and add any additional information that will assist the District Project Committee in their consideration of your application.
A Description of the Project:
Project Total Cost: $
(provide a detailed budget)
Funds Requested from the District Project Fund: $
Source of the matching funds:
Club(s): Contact Person:
Home Phone
Work Phone Address
City State
Zip
Email address
After you submit the form, you will be able to print a copy of your submission for your records.
Eric Paulsen Door County Eye Assoc.