Room Rebate Application
GENERAL INFORMATION
Organization Name
*
Event Name
*
Primary Contact First & Last Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Arrival Date
*
Departure Date
*
Number of Attendees
*
'Other' (further information you would like to provide that was not requested above)
SLEEPING ROOM FORECAST
Number of guest rooms needed per night.
*
Total number of each: single, double, triple, quad
*
SPECIAL REQUESTS
ADA rooms, locations airport transportation, etc.
*
Tax ID number or EIN
*
Upload W9 HERE
*
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I have read the application guidelines and all of the information included in this application is true and accurate. I understand that submitting this application does not guarantee funding and is not a formal contract. A formal contract will be signed upon awarding of funds.
*
Yes, I agree
Date
*
-
Month
-
Day
Year
Date
Signature
*
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