Name of OrganizationStreet AddressApartment, suite, etcCityStateZIP / Postal CodePrimary Contact NamePrimary Email AddressPrimary PhoneSecondary Contact NameSecondary Email AddressSecondary PhoneEvent NameEvent TypeEvent AddressCityStateZIP / Postal CodeStart DateTimeHours–120102030405060708091011Minutes–000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859AMPMEnd DateBrief DescriptionList any Rolla area businesses you'll be usingProjected Number of Hotel RoomsProjected Number of ParticipantsLiability Insurance ProviderPolicy NumberRequested Amount of FundsUSDBrief Outline of Income & ExpensesBrief Description of How Grant Funds Will Be UsedAre you seeking sponsors for your event?YesNoEvent Website Link (if applicable)Facebook Event link (if applicable)Ways you plan to market your eventI understand and agree to comply with all VisitRolla logo placement requirements for this grant.I confirm that I have obtained all required permits and licenses, including liquor and city permits, if applicable.I understand that funding is not guaranteed, this is a reimbursement-based grant, and all expenses must comply with Destination Rolla Grant guidelines.I agree to provide any additional information requested and understand that I may be asked to appear before the Destination Rolla Grant Committee if further details are needed.Applicant Name *Date *Submit ApplicationDestination Rolla Grant DraftPlease do not fill in this field.
