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DISTRICT PROJECT FUND APPLICATION


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. 


Chair

Eric Paulsen
Door County Eye Assoc.