Lift the Ban Coalition Gathering – request help with travel Organisation / Group Name Primary contact person* Phone number* Email address* Please give details about your planned journey, including where you are travelling from, how many people are travelling and the method of travel*What is the estimated total cost that you will be requesting? (for all delegates)* Is this figure…?* An estimate Definite Please note that funding is not guaranteed until your application has been accepted so you may wish to wait before purchasing tickets if you have no alternative sources of funding. If your tickets increase significantly in price after your application has been approved, please check with us before buying. Declaration*I declare that all of the information contained in this application is correct. I accept the terms and conditions of this fund. I accept that by submitting this application that any subsequent discovery of intentionally falsified or misleading information may invalidate the offer of financial assistance under this fund. I Agree