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2. Activity Information
4. Organization*
5. Activity Name*
6. Activity Type*
8. Year*
9. Start Date*
   Start Date
10. End Date*
    End Date
12. Funds Required*
13. Funds Awarded*
14. Total Activity Cost*
16. Notes
18. Overall Attendance
20. Predicted*
21. Actual*
22. Method*
24. Please explain*
26. Attendance, 50+ Miles
28. Predicted*
29. Actual*
30. Method*
32. Please explain*
34. Attendance, Out of State or Country
36. Predicted*
37. Actual*
38. Method*
40. Please explain*
42. Attendance, Paid for Overnight Lodging
44. Predicted*
45. Actual*
46. Method*
48. Please explain*
50. Attendance, Did Not Pay for Overnight Lodging
52. Predicted*
53. Actual*
54. Method*
56. Please explain
58. Paid Lodging Nights
60. Predicted*
61. Actual*
62. Method*
64. Reimbursement
66. Please combine all itemized receipts into one PDF file for review. *

    Each receipt should include the vendor's name and the amount being requested for reimbursement.

68. Total to be reimbursed*
69. Total funding approved by City*
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71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field