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Foreningens/Lagets navn:
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Adresse:
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Leder: ________________________ Tlf.: ____________ E-post: __________________
Kasserer: ______________________Tlf.: ____________ E-post: __________________
Lagets bankkontonummer: ___________________
Foreningens/Lagets formål: ________________________________________________
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Antall medlemmer under 18 år: _________ Over 18 år: _________
Kort beskrivelse av formål, virksomhet og arbeidsoppgaver:
Eget møtelokale/hus/anlegg: _______________________________________________
Spesielle opplysninger: ____________________________________________________
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Dato:
____________________________
Underskrift ____________________________________
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Postboks 83, 1751 Halden
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