<p> Verona Area Chamber of Commerce Tourism Grant Request Form</p><p>Date: ______</p><p>Organization Name: ______</p><p>Contact Person: ______Phone #: ______</p><p>Address: ______</p><p>Email Address: ______Fax #: ______</p><p>Project / Event Information</p><p>Name of Project/Event: ______</p><p>Project/Event Date(s): ______</p><p>Event Location/Site(s): ______</p><p>Person(s) responsible for coordination of Event/Project: ______</p><p>Please describe the event/project as completely as possible (attach additional sheets if necessary): ______</p><p>How will the event/project promote visitors to come to Verona? ______</p><p>What market are you targeting and why? VACC Tourism Grant Request Form Revision Date: 2/11/09 Page 1 of 3 If you intend to use the grant toward an event, please provide your best estimated answer to the following questions. Applicants will not be held liable if estimates are inaccurate, but failure to estimate could result in your application being denied.</p><p>Please estimate the number of people who will be directly participating in this event: ______</p><p>Please estimate the number of non-participants who will come to Verona for this event (parents of participants, spectators, etc.): ______</p><p>How many of these people live outside Verona? ______</p><p>How many of these people live outside Dane County? ______</p><p>Is this an annual event? Y N Do you anticipate it becoming and annual event? Y N</p><p>Do you anticipate people attending this event will require hotel accommodations? Y N</p><p>Financial Information</p><p>How much money are you requesting from the Verona Area Chamber of Commerce for this event? $______</p><p>If grant is provided in full, the grant would be ______percent of the total project/ event budget.</p><p>Please describe in detail how grant money from the Verona Area Chamber of Commerce would be used to fund your event/project and how your request fulfills Section 66.0615(1)(fm) of the WI State Statues ( ... must be spent on marketing projects to attract tourists… reasonably likely to generate paid overnight stays…). If applicable, describe how the funds from the Verona Area Chamber of Commerce would enhance your event in comparison with previous years. Also include any other information you feel would be relevant in evaluating your application. You may complete this answer on a separate piece of paper, if necessary.</p><p>A Summary Report must be submitted to the Verona Area Chamber of Commerce within thirty (30) days of your event. Summary information must include (but is not limited to) </p><p>VACC Tourism Grant Request Form Revision Date: 2/11/09 Page 2 of 3 the following: number of attendees, number of overnight hotel stays, and an explanation of how room tax funding was spent (include receipts, where applicable).</p><p>In applying for a Verona Area Chamber of Commerce Tourism Grant, I understand that grant money is intended to promote tourism, economic development, and/or general community well- being within Verona. I further understand this application for a grant does not guarantee acceptance. I agree to provide additional information to support this application if requested, and will appear in person before the Chamber’s Room Tax Subcommittee if required. I agree to comply with any stipulations placed on my grant by the Verona Area Chamber of Commerce.</p><p>Name (print): ______Organization: ______</p><p>Signature: ______Date: ______</p><p>Office Use Only</p><p>Date Received: ______</p><p>Granted: $______Date: ______</p><p>Financial Info Received: ______Date: ______</p><p>Summary Report Received: _____ Date: ______</p><p>Notes: ______</p><p>Denied: ______Date: ______</p><p>Reason for Denial: ______</p><p>______</p><p>______</p><p>VACC Tourism Grant Request Form Revision Date: 2/11/09 Page 3 of 3</p>