Conference Financial Support Application - Meet In Ireland

APPLICATION FORMCONFERENCE AMBASSADORFINANCIAL SUPPORT SCHEMEIMPORTANTBefore completing this form, please read the Conference Ambassador Support SchemeGuidelines.January 20131

Please complete all areas of the following pages and insert “N/A” where notapplicable(If you have any queries relating to the completion of the form, please contact Geraldine Jeffers at+353 (42) 9339748 or geraldine.jeffers@failteireland.ie)Date of Application:Note: If you are a Professional Conference Organiser or Destination Management Company, pleasecomplete all sections. All other applicants, please proceed to Section B.Section A - Professional Organiser Details (to be completed by PCOs only)Name of Professional Organiser:Contact Name in Company:Phone Number:e-mail address:Section B - Applicant’s DetailsName of ApplicantPosition:Address:Phone Number:e-mail address:Website address:Section C – National Association DetailsName of Contact:Name of National Association,Company, College or other:Address:Phone Number:e-mail address:Website address:2

Section C - International Association’s DetailsName of International Association orOrganisation:City and Country of InternationalAssociation:Web Address of InternationalAssociationSection D - (To be completed by Conference Ambassadors only)Are you or do you intend using aProfessional Conference Organiser?Y/NIf “yes”, please provide CompanyName and Contact detailsSection E – Conference DetailsConference Title (Full):Conference Acronym or Short Title:Conference Subject Matter, i.e. SectorConference Web AddressLocation, i.e. CountyVenueDates of ConferenceMonth of ConferenceYear of ConferenceEstimated Number of Delegates% of Overseas DelegatesNumber of Nights per DelegateFrequency of Conference (annual,biennial, etc.)Location and year of previous threeconferences3

Section F – Application DetailsApplication Category, i.e. Bid or CommittedConferenceHave you secured any funding from Failte Ireland(including Fáilte Ireland Regions), Tourism Irelandor your local Convention Bureau, including Bidand/or Site Inspection for this conference?If “Yes” to above, please provide details andattach pages where necessary:Will there be opportunities for Ireland to attractfuture conference business as a result ofsupporting this conference. If so, please providedetails of these opportunities4

Section G – Support (provide details of your projected costs/activity by completing all unshaded boxes)Expense CategoryBid SectionYear ofExpenditureEstimatedExpenditureNo. ofPeopleNo. ofDays/NightsDetails- Bid Document costsTravel costs topresent bidAccommodationcostsCountryCity(Insert name of country & city):Ireland Networking EventSite Inspection Section- Travel costs- AccommodationcostsMarketing SectionDo you wish to claimmarketing support?Y/N5

Section H - Please let us know how you became aware of our Trade Support ProgrammeThrough contact from Failte Ireland, name of contact:Website, name of website:Trade Show, name of trade showAdvertorial, name and date of paper or magazine:Educational Event, name of venueConference Ambassador Club, name of venueOther – please state:6

N.B. It is most important to read carefully, sign and date the following pages:Failte Ireland ResearchIt is a condition of being granted trade support that you confirm your willingness to permitFailte Ireland to conduct research at the above conference. The research is for statisticalpurposes only and all findings will be an amalgam of data; and individual conference details willbe treated in the strictest of confidence.I agreeName(in block capitals):Signed:Date:Disclosure of Information – Freedom of Information ActFáilte Ireland wishes to advise applicants that, under the Freedom of Information Act 1997 andAmendment 2003, the information supplied in the application form may be made available onrequest, subject to Fáilte Ireland’s obligations under law. Please sign below to indicate youracknowledgement.I acknowledge that Failte Ireland my have to supply information provided by meunder the Freedom of Information Act.Name(in block capitals):Signed:Date:7

DISCLAIMER – PLEASE READ THE FOLLOWING CAREFULLYIt will be a condition of any application for funding under the terms and conditions of the FáilteIreland Conference Financial Support Scheme that the applicant has read, understood andaccepted the following:1. Fáilte Ireland shall not be liable to the applicant or any other party, in respect ofany loss, damage or costs of any nature arising directly or indirectly from: the application or the subject matter of the application the rejection for any reason of any application.2. Fáilte Ireland shall not be held responsible or liable, at any time in anycircumstances, in relation to any matter whatsoever arising in connection with theadministration of activities.Applicant’s StatementI/we certify that I/we read and understood the Guidelines and criteria applicable to the FáilteIreland Conference Financial Support Scheme and agree to comply in full therewith. I/we certifythat all information provided in this application, and all information given in any documentationsubmitted in support of the application is truthful and accurate.Signed: ___________________________________________________________________Date: ____________________________Name (in block capitals):________________________________________________________On behalf of (organisation'sname):_________________________________________________Completed forms to be forwarded to:Ms Geraldine JeffersBusiness Tourism OfficerFáilte IrelandJocelyn StreetDundalkCo. LouthTel: + 353 42 9339748E-Mail: geraldine.jeffers@failteireland.iewww.meetinireland.com8

Account Set-Up FormTo be competed by the applicant (Please type details)Fáilte Ireland’s preferred method of payment is by electronic transfer. If your organisation details have not already beensupplied to Fáilte Ireland, please complete this form.Please complete all sections and sign below as forms will not be accepted without signature.Applicant Company/Association Name:Conference TitleTrading Name (if different to above)Full Postal Address- Street name 1- Street name 2- Town- County- Country- PostcodeFull Telephone Number (incl. internationaland area code):Full Fax Number ( Include full int’l and areacode)Description of business supplied to FáilteIrelandCategory Code (Fáilte Ireland to Code)Professional Type Service (Y/N)Fáilte Ireland Business ContactCurrency of InvoicesName of Bank Account HolderName & Address of BankBusiness Tourism SupportMP06Geraldine JeffersBank Sort Code:Bank Account NumberIBAN NumberBIC/Swift AddressTax Reference Number (please specifytype VAT, PPS, CHY or other)e-mail address for remittance advicee-mail address for purchase ordersSigned by: ______________________________________ Typed Name:___________________________________Position:Company Stamp:______________________________If any of your details should change, please notify usimmediately to ensure payment is made to the correctpayee and bank account.Please attach a business compliment slip or business card in absence of companystamp. Professional Services Withholding Tax, if applicable, shall be deducted at thestandard rate from any payments made by Fáilte Ireland for Services pursuant to anyPurchase Order. Please refer to the Department of Finance Website: www.finance.gov.ie9