Visitor Booking Form

CONEXPO/CONAGG 2017

7TH- 11TH March 2017
Las Vegas Convention Center

www.conexpoconagg.com

SECTION A: COMPANY DETAILS
1. Company Name / 3. Contact Name
2. Full Address / 4. Telephone
5. Mobile
6. Email
7. Website
8. Invest NI Client / Yes / No / 9. Client Executive’s Name
10. Number of Employees / 11. Annual Turnover
SECTION B: COMPANY PROFILE / BACKGROUND INFORMATION
Please provide a brief company profile including details on the products/services you offer
SECTION C: PREVIOUS AND CURRENT EXPORT ACTIVITY
1.  Do you currently export ANY product/service outside GB?
NB: Republic of Ireland is considered an export market
If yes, please answer the following / Yes / No
(a) To which markets?
(b) Value of Sales to GB
(c) Value of Exports outside GB
(d) Do you currently sell to the North American market?
If yes please state the value of sales to date? / Yes
No
SECTION D : OBJECTIVES FOR PARTICIPATION IN THIS EVENT
Please state below your objectives for participating on this event
1
2
3
4
SECTION E : ADDITIONAL SUPPORT
Please indicate below if you require the following support
Sales training / Yes / No
Pre-show targeting of buyers / Yes / No
Product presentation / Yes / No
Following up on sales enquiries / Yes / No
Other (please specify) / Yes / No
SECTION F: YOUR COMMITMENT & DE MINIMIS AID
If you have received Government funded business support such as grants or subsidised consultancy from other Government Departments, Intertrade Ireland or Local Councils over the last 3 years this might impact on your eligibility to receive a grant as the Trade Solutions scheme operates as ‘De Minimis’ aid.
The maximum amount of De Minimis aid that an undertaking (individual company or company group) can receive within a 3 year fiscal period is €200,000. To allow us to determine whether awarding this grant will breach this limit, please complete the table below that details the date and value of any De Minimis aid you have received during your last 3 fiscal (accounting) years.
Please note that it is your responsibility to check whether the support you have received was classed as ‘De Minimis’ aid. If in doubt, please check with whoever provided you with the support.
Has your business received any form of public support or grant that was classed as De Minimis in the last 3 years?
If ‘Yes’, please provide detail in the table below:- / Yes / No
Date support/grant funding awarded / Funding body / Purpose / Scheme / Amount
Total
What is the date of the end of your accounting (fiscal) year (dd/mm)?
Invest NI De Minimis Schemes
To assist you in determining the De Minimis support you have received in the last three accounting years, a list of Invest NI’s De Minimis programmes is attached at Annex A along with the value of that support where appropriate. Please note that this is not a comprehensive list of De Minimis support available in Northern Ireland
A.  I confirm that:
v  The details provided on this form are current and accurate to the best of my knowledge.
v  The company is solvent and no distress or execution has been levied against it.
B.  I understand that completion of this form neither entitles nor requires me to take part in any particular business support services in the future.
C.  I understand that it is Invest NI’s intention to accommodate as many Northern Ireland companies on the NI group stand as is possible and that in the event of oversubscription, Invest NI reserves the right to limit the size of the individual stands and to apply a selection process if necessary.
D.  I enclose my deposit/participation fee of £300.00 (cheques payable to Invest NI)
Name
Position in Company
Signature
Date

Annex A Invest NI De Minimis Schemes

Programme / Scheme / Value of De Minimis Aid
Accelerated Support Fund / Letter of Offer Value
Boosting Business through Grant for R&D / Letter of Offer Value up to max £50k
Business Improvement Agent / Letter of Offer Value
Business Solutions Consultancy / Letter of Offer Value up to a maximum of £15,800
Carbon Trust Interest Subsidy on loans / Determined by size of loan
CE Marking Programme / £1,995
Collaborative Networks Programme / Value stated in the Collaborative Networks confirmation letter
Design Programme / Main Design Project: £7,000*
Mini Design Project: £3,500*
Green Technology Initiative / Letter of Offer value
Growth Accelerator Programme / Letter of Offer value
Innovation Vouchers / £4,000*
Non Executive Director Programme / Letter of Offer Value up to a maximum of £15,000
Northstar Mentoring Assignment / Mentoring Costs up to £800*
Propel Programme / Letter of Offer value
Resource Efficiency Audit Framework / Agreed Consultancy Costs up to £1,000*
Sustainable Development Implementation Framework / Agreed Consultancy Costs up to £5,000*
Technology Development Incentive / Letter of Offer Value up to a maximum of £5,000
Trade Solutions / Trade Solutions support varies and may be up to £20,000.
Contact the Trade Team directly for programme value

N. B. * indicates the maximum level of support available against the given support mechanism

It is Invest NI’s policy to conduct all of its business in an honest and ethical manner. Invest NI takes a zero-tolerance approach to bribery and corruption and is committed to acting professionally, fairly and with integrity in all its business dealings and relationships wherever it operates and implementing and enforcing effective systems to counter bribery.

Please return to Catherine McCallan,

CONEXPO/CONAGG 2017 – Booking Form Page 1