To be reimbursed, please submit the following:
1. Valid invoice(s) for allowable expenses. Please submit only enough PAID receipts to reach awarded grant amount.
2. Copy of PAID vendor invoice showing a zero-balance due. Cash receipts will not be accepted without written confirmation from vendor that expenditure has been paid in full. For all media buys, please provide tear sheets, copies of advertisements, schedules and signed station affidavits.
3. Number of visitors calculated listed below.
4. Number of room nights tracked listed below.
5. Copies of marketing or advertising materials, websites showing CCCVB’S logo.
Grant Information
Name of Event*
Date(s) of Event*
Contact/Title*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Telephone #*
Awarded Grant Amount ($)*
Email*
Make Check Payable To: (Please Note – Organization must be same as organization that was awarded grant.)*
Tax I.D. #*
EXPENSES TO BE REIMBURSED
Itemized expenses to be reimbursed by CCCVB’s grant funds must be allowable and match submitted invoices. (Expense Item, Amount)*
Total ($)*
VISITORS
Out-of-town Participants*
Participant = (attendees, athletes, coaches, officials, visiting artists, speakers, production crews)
Visitors*
Visitor = (family + spectators) from out of town.
Event Attendees/Ticket Sales*
May include locals
Total*
Attendees = (participants + out-of-town visitors)
ROOM NIGHTS
To calculate the total number of room nights, multiply number of rooms by the number of nights (i.e.: 5 rooms for 4 nights = 20 room nights) • Unknown or untracked is not acceptable and request for reimbursement will not be processed. • Please provide explanation if actual room nights are different than what was reported as anticipated room nights
HOTEL PROPERTY / STREET ADDRESS + ROOM NIGHTS*
MEDIA / MARKETING
Provide summary of media exposure received (local, regional and national print, television, online and radio) as well as examples of promotional materials (brochures, posters, programs, etc.). Please add additional sheet if needed.*
COMMUNITY EVALUATION
Please rank the following entities and services utilized during your event, and rank from 1 to 10, 10 being high and 1 low:
Hotel/Lodging Accommodations
Hotel 1 Name
Hotel 1 Ranking
Hotel 2 Name
Hotel 2 Ranking
Hotel 3 Name
Hotel 3 Ranking
Hotel 4 Name
Hotel 4 Ranking
Hotel 5 Name
Comments
Venue 1 Name
Venue 1 Ranking
Venue 2 Name
Venue 2 Ranking
Venue 3 Name
Venue 3 Ranking
Comments
Food and Beverage 1 Name
Food and Beverage 1 Ranking
Food and Beverage 2 Name
Food and Beverage 2 Ranking
Food and Beverage 3 Name
Food and Beverage 3 Ranking
Comments
Campbell County Convention & Visitors Bureau Staff/Services Name
Campbell County Convention & Visitors Bureau Staff/Services Ranking
Comments
Any Tours and/or Attractions 1 Name
Any Tours and/or Attractions 1 Ranking
Any Tours and/or Attractions 2 Name
Any Tours and/or Attractions 2 Ranking
Any Tours and/or Attractions 3 Name
Any Tours and/or Attractions 3 Ranking
Comments
Other Services Used 1 Name
Other Services Used 1 Ranking
Other Services Used 2 Name
Other Services Used 2 Ranking
Comments
How likely are you to recommend the Gillette/Wright/Campbell County area to others? Ranking
Please include additional comments you would like to add below
Please mark YES if you would like a representative from the Campbell County Convention & Visitors Bureau to contact you directly*
- Yes
- No
If Yes - Contact Information
I certify that the above information is true and accurate to the best of my knowledge.
Signature*
Organization*
Date*
MM slash DD slash YYYY
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Grant Information

EXPENSES TO BE REIMBURSED

VISITORS

ROOM NIGHTS

MEDIA / MARKETING

COMMUNITY EVALUATION

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