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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: —�«lg <br />Applicant Signature: <br />-_TCO\ \ Ko.ftxvS <br />D n1T" <br />Printed Name: <br />--------------------------------------------------------------- <br />- resident <br />M tuber <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />ember <br />Member <br />Member <br />Date <br />