Special Event - Scholarship Walk-A-Thon - September 18

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C"w"City of South Bend Special Event Application dCity and Regional Event '�$50 application fee if filed 60 days or greater (up to 360 days) in advance of event $100 expedited application fee if filed 30-59 days in advance of event Review the Instructions on the Special Events page before completing the application. City and Regional Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Section A - Applicant Information August 23 2021 Pentecostal Church Fine Arts Dept Date of Application: _ � Organization Name:___________________ Applicant (Contact) Name: Karen L. White Applicant (Contact) Phone: 574-229-3100 Contact Email: kwhite4211@gamil.com _ Address: 1912 Malvern Way__ _ city/state/ZIP: South Bend, IN 46614 List any professional event organizer, event service provider or commercial fundraiser that is authorized to work on your behalf to plan, produce and/or manage your event. Organization Name: Contact Phone: Address: Contact Name: Contact Email: City/State/ZIP: Section B - Event Information Event Name: Scholarship Walk_A-Thon Event Type: (Festival, Race, Parade, Other): Walk Event Classification: N Non -Profit` ❑ For -Profit ❑ City (Civic) Sponsored ❑ Other (if Other, please describe): 'The Special Events Committee may request proof of non-profit status. Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this application. The description should be a summary overview.) Pentecostal Church Fine Arts Dept. 1025 West Western Avenue South Bend, IN 46601. Walk- A -Thon for Scholarship. Date of Event Setup [mm/dd/yy]: 09/18/2021 Begin Date of Event [mm/dd/yy]: 09/18/2021 End Date of Event [mm/dd/yy]: 9/18/2021 Event Cleanup Completion [mm/dd/yy]: Total anticipated attendance: 30-40 Time: none Time: 10_am Time: 12 Noon Time: The proposed event will require the closing of: ❑ Streets ❑ Sidewalks