Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
Phone Number
-
Area Code
Phone Number
Support Group Name
Support Group Position
Support Group Area
Support Group Website
Support Group Facebook Page
Is your group listed at http://ukfibromyalgia.com/pages/support/support_map.php ?
Please Select
Yes
No
Does your group website link to UKFM?If not, please add a link using http://ukfibromyalgia.com/linkback.php
Please Select
Yes
No
Does your group subscribe to the Fibromyalgia Magazine?
Please Select
Yes
No
How many meetings do you average per year?
How many regulars do you have attending your meetings?
Do you produce your own in-house newsletter?
Please Select
Yes
No
Could you take some photographs of your group and write some copy about your plans for the group and the event(s) if the grant was successful? (I like to feature an article on the groups helped in magazine.)
Please Select
Yes
No
Could you include an advertisement for magazine subscriptions in your in house publicity and your website if the grant goes ahead?
Please Select
Yes
No
Background information about what the money is needed for:
Funding required (maximum £100.00)
Have you applied for a grant from us before?
Please Select
Yes
No
Date you require the money
/
Day
/
Month
Year
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Cheque payable to (if your application is successful, you should be aware that I can only pay out grants to named support groups, not to private individuals' accounts)
Additional comments
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