Request Patronage

Name of Organization*
Name of Contact Person
First Last
Address
Street Address City Parish/State Country
Phone
Email
Address of Organization
Street Address City Parish/State Country
Email
Phone
Brief statement of the overarching purpose of your organization, its objectives, activities and future plans:
Year your organization was founded:*
Date Format: MM slash DD slash YYYY
Name(s) of Current Patrons*
Year your organization was first granted Viceregal Patronage? (if Patronage was granted)
Identify any major projects or future plans
What specific involvement by The Governor-General do you seek?*
How is your organization funded?*
Does your organization receive corporate sponsorship? If so, indicate the source?
Please provide the name and contact information of a local body or key authority in your sector of interest that will support this request for Patronage
Additional comments in support of this application:
Email
This field is for validation purposes and should be left unchanged.