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I have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of <br />the information provided by me to the best of my knowledge. I understand and agree to the above rules <br />and regulations, and any applicable state and federal laws. I also understand that this application may be <br />denied based on any false or incomplete information. <br />Date: 0 to Z q Z <br />Applicant Signature: <br />Printed Name: Lt f� 1� b X212 \ ------- ------------- <br />President <br />------ 4-X-41 <br />Member <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Member <br />� . '^ <br />--A cl, <br />Mem <br />Member <br />7•C -a-1 <br />Date <br />