AC Fund Panel Application Form – Auchenblae's Community Website

Name

First

Last

Community Group memberships and positions held

Address*

Tel(Day)*

Tel(Evening)*

Email*

Please give a brief indication as to why you wish to join the panel:

I understand that my contact details will be stored electronically by ADCA.They will not be shared with any third party and will only be used for the purpose of fund administration.

I am over 16 years of age and am resident in the Auchenblae Electoral Ward.

I understand that all information I receive pertaining to applications is confidential and I agree that I will not share or discuss applications with any other person. I accept that I will be permanently disqualified from the panel if I breach this agreement.

Signed*

Date*

Are you human?*