Helix-Heart of the Country-Rodeo
Request for Funds

Date: _________________________________

Name: ______________________________________________________________________

Organization:  ________________________________________________________________

Address: ____________________________________________________________________

City, State, ZIP: ______________________________________________________________

Amount Requested: ___________________________________________________________

Total Cost of Event (Camp, trip, sports fee, etc.): ____________________________________

Brief Description of Event and Funding Need:  ______________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Signature of Representative: _____________________________________________________

Make Check Payable to: ________________________________________________________

Address (if other than listed above) ________________________________________________

_____________________________________________________________________________

~For Official Helix Rodeo Board use only~

Approved ________ Denied ________ Date _________________________________________

Amount Approved: _____________________________________________________________

Signature of Helix Rodeo Representative: ___________________________________________

Paid - Check # _________________ Date __________________                    HOME