LiveLife Helping Our Community As part of LiveLife Pharmacies goal of giving back to the Community, we are opening submissions to Local Charity, Community and Support Groups to participate in our “LiveLife Community Support Program”. Each group chosen to participate will be allocated a specific month and will receive funds donated by the local LiveLife Pharmacies. To be a part of this exciting community initiative please complete the below submission form. Charity, Community or Support Group Name Which local LiveLife Pharmacy would you be able to visit for a photo with the LiveLife Team and to sign for the funds? Contact Name Phone Bank Account Details BSB Account Number Account Name In order to verify the account holder of the above details we require a copy of a deposit slip or the top of a bank account statement to be attached. Email Proposed use of funds (50 words or less) As part of this submission I/we agree to be a part of LiveLife Catalogues, website and print promotions of the LiveLife Support Program.