Application For A Raffles License Form Page 3
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4Part E - Officers of Applicant
(1) Office
Name of officer
Age
_______________________________________________ _________________________________________________ _____
Residence address
Telephone No.
(include area code)
_______________________________________________ Day _______________________ Evening ______________________
(2) Office
Name of officer
Age
_______________________________________________ _________________________________________________ _____
Residence address
Telephone No.
(include area code)
_______________________________________________ Day _______________________ Evening ______________________
(3) Office
Name of officer
Age
_______________________________________________ _________________________________________________ _____
Residence address
Telephone No.
(include area code)
_______________________________________________ Day _______________________ Evening ______________________
(4) Office
Name of officer
Age
_______________________________________________ _________________________________________________ _____
Residence address
Telephone No.
(include area code)
_______________________________________________ Day _______________________ Evening ______________________
Part F - Members of Applicant who will be in charge of the games
Telephone No.
Age
(include area code)
Name of member in charge
Residence address
Day / Evening
_____________________________ ____________________________________ ______________ / ______________ _____
_____________________________ ____________________________________ ______________ / ______________ _____
_____________________________ ____________________________________ ______________ / ______________ _____
_____________________________ ____________________________________ ______________ / ______________ _____
_____________________________ ____________________________________ ______________ / ______________ _____
Part G - Members of Applicant who will assist in conducting the games
Name of member
Residence address
Age
________________________________________ ________________________________________________________ _____
________________________________________ ________________________________________________________ _____
________________________________________ ________________________________________________________ _____
________________________________________ ________________________________________________________ _____
Part H - Names of other organizations whose members will assist in conducting the games
Name and address of organization
How related
Identification No.
______________________________________________________ ___________________________ ____________________
______________________________________________________ ___________________________ ____________________
______________________________________________________ ___________________________ ____________________
Part I - Statement of Applicant and member(s) in charge
If more space is needed in any section of this application, insert extra sheets of paper.
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