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Downtown Special  Event  Grant  Application  

Applicant Information     Contact  Name:  _________________________________________________________________     Organization:  __________________________________________________________________     Contact  Address:  _______________________________________________________________     City:  ___________________________            State:  _________          Zip  Code:  ___________________     Phone  Number:  _____________________      Email:  ___________________________________       Event  Information     Event  Name:  ___________________________________________________________________     Date  of  Event:  ______________________      Event  Location:  ____________________________     Explain  the  impact  your  event  will  have  on  Downtown  Dodge  City.    _______________________________     ________________________________________________________________________________________________________     ________________________________________________________________________________________________________  

Explain  your  need  for  funding  assistance  through  the  grant  program.  _____________________________     ________________________________________________________________________________________________________     ________________________________________________________________________________________________________        

Explain how  the  event  will  be  marketed  and  advertised.  ___________________________________________     ________________________________________________________________________________________________________     ________________________________________________________________________________________________________  

  Total  Event  Budget:  $_____________    

Grant Request  Amount:  $_______________  

*Please attach  the  itemized  event  budget  and  proof  of  insurance.      

Grant funding  made  possible  through  the  Mariah  Fund  

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AUTHORIZATION/CERTIFICATION OF  APPLICANT     I  acknowledge  and  understand  that  approval  for  grant  funding  in  no  way  creates  liability  of  any   kind  of  whatsoever  on  behalf  of  Main  Street  Dodge  City,  Inc.  and  agree  to  indemnify  and  hold   Main  Street  Dodge  City,  Inc.  harmless  from  any  and  all  liability.     Applicant  Signature:  ______________________________         Date:  __________________       Email,  mail,  fax  or  drop  off  completed  grant  applications  to:   Main  Street  Dodge  City   311  W.  Spruce,  PO  Box  818   Dodge  City,  KS  67801   Phone  –  620.227.9501   Fax  –  620.338.8734   cdawson@dodgedev.org       -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐     FOR  OFFICE  USE  ONLY     Date  Received:  ________________       Promotion  Committee  Recommendation     APPROVED    !      (OR)      REJECTED    !          Signature_____________________  Date  _________     Comments:         FINAL  APPROVAL       APPROVED    !      (OR)      REJECTED    !          Signature_____________________  Date  _________     AMOUNTED  AWARDED:    $___________________         Grant  funding  made  possible  through  the  Mariah  Fund  

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Special event grant application  
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