Leon County Tourism Development (Visit Tallahassee)

Transportation Fund Application for Meeting & Conventions

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Please submit the following documentation along with the Transportation Funding Application:

1) Completed and Signed W-9 Form for Reimbursement

2) Copies of Counter-Signed Hotel Contracts

3) Conference/Meeting Agenda

4) Proof of Liability/Medical Insurance

1. Name of Meeting:
2.Dates of Meeting/
Convention:
Start time: / End Time:

3. Description of Meeting (Include scope of meeting attendees; i.e.: regional, state):

4. Host Company/
/ Organization:

5. Description of Company/Organization (include date organization was created):

. Contact Person:

(Name) (Title)

Address:
City: / State: / Zip:
Daytime Contact #: / ( ) / Email Address:
Fax Number #: / ( ) / Website: / www.

7. Non-Profit Organization:

Tax I.D. #:
or
Social Security #:

(This information is required)

8. Liability/Medical Insurance:

Name of Carrier:

Leon County Tourism Development XXX

Transportation Fund Program

(Please include Proof of Insurance Coverage in Application packet)

XXX

9. Has venue/facility been secured?

If so, please list:

Is site located within Leon County?

Contact Name and Day Phone #: / ( )

10. Has hotel been secured?

List hotels and provide hotel contract
including number of blocked room nights per date.
Contact Name and Day Phone #: / ( )

Would you like to be contacted by hotels or event service providers?

1 11. Anticipated # of out-of-town overnight visitors
Anticipated # of attendees:

12. Anticipated # of Room Nights:

Date / Hotel & Contact Name / Room Nights
(# rooms x # nights)

13. Room Night History of Event (if applicable):

Dates / Hotel & Contact Name / Room Nights
(# rooms x # nights)

14. Event Budget (itemize general categories of event income/expenses):

Income: / Amount
Expenses:
(Attach additional pages if needed.) Net Profit/(Loss)

15. What plans have been made for promotion?

16. Amount of funding requested: $
Intended use of funds:

17. Have you received a Leon County Tourism Development funding in the past?

If yes, include amount, name of event and year received:

Amount / Name of Event / Year

18.  Community Support

1.  Please list any city, county, TDC, or other cash contributions from public entities for this event (include amount and source):

2.  Please outline any in-kind support from the community that has been committed for this event (i.e.: donated facilities, volunteer/staff support, city/county services, etc.)

3.  Please outline any local corporate sponsorship support that has been secured for this event.

CERTIFICATION AND COMPLIANCE STATEMENT

APPLICANT:

I hereby certify that the information contained in this application is true and correct to the best of my knowledge and that I have read the Policies and Procedures of the Leon County Tourism Development (Visit Tallahassee) Transportation Fund Program and will abide by all legal, financial, and reporting requirements as a condition of receiving funds from Leon County Tourism Development. Signatures must be original in blue ink.

Name:

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Organization:

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(Signature) (Date)

Please return the application and the Certification & Compliance Page to:

Janet Roach, Meetings & Conventions Director

Leon County Tourism Development (Visit Tallahassee)

106 East Jefferson Street

Tallahassee, FL 32301


(850) 606-2320

Leon County Tourism Development 3 Transportation Fund Program