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Middleburg Special Event Funding Request

2. 

3. MIDDLEBURG, VIRGINIA - SPECIAL PROJECT OR EVENT FUNDING REQUEST

5. Primary Contact Information

7. First Name

8. Last Name

10. Address

12. City

13. State

14. Zip Code

16. Email Address*

21. Organization Information

23. Organization Name*

24. Website*

26. Federal Tax ID Number*

27. Years of Operations in Middleburg

28. First Time Applicant?

    1. Yes
    2. No

30. Address

32. City

33. State

34. Zip Code

38. Please attach the most recent year-end financial statement or audit*

42. Proposal Information

44. Is this a new or existing project or event?

    1. New
    2. Existing

46. Describe your organization, including any notable accomplishments or milestones

48. Describe your proposed project or event

50. Is the event weather dependent?

    1. Yes
    2. No

51. Are multiple organizations involved?

    1. Yes
    2. No

53. List multiple organizations (if applicable)

55. Describe your organization's experience related to the new or existing project or event.

57. How much funding is being requested?

    Please note that requests that exceed $10,000 require a 1:1 match

58. Provide a budget for the project or event.*

60. Additional funding sources

    List all additional funding including in-kind donations that your organization has secured for this project or event.

62. How will the proposed project or event result in increased spending by visitors to Middleburg? How will you measure an increase in spending?

64. How many visitors will this proposed project or event generate?
    -- Select One --less than 100100 - 500500 - 1,0001.000 - 2,500greater than 2,500

65. How will you measure the number of visitors?

67. Marketing Information

    Describe how the intended audience (residents and visitors to the area) will learn about the project or event.

69. Please attach a marketing plan (if applicable)

71. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
73. Electronic Signature*

Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field