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12/15/2022 <br />irk City of South Bend Special Event Application <br /><< <br />City and Regional Event <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Bring Completed Application and Pavmentto: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. City and Regional Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />i • r lint r. u <br />Date of Application: 12/15/2022 Organization Name: Girls on the Run Michiana <br />Applicant (Contact) Name: Annie Diroll <br />Applicant (Contact) Phone: 574-5324051 a Contact Email:annie.dirollloDgidsontherun.org <br />Address: 51160 Bittersweet Rd., Ste 202City/state/ZIP: <br />Granger, IN 46530 <br />List any professional event organizer, event service provider or commercial fundraiser that is authorized to work <br />on your behalf to plan, produce and/or manage your event. <br />Organization Name: <br />Contact Phone: <br />Address: <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />Event Name: Girls nn tha Rijn Mirhiana SK Event Type: (Festival, Race, Parade, Other): 5K Run/Walk <br />Event Classification: 9 Non -Profit" ❑ For -Profit <br />❑ City (Civic) Sponsored ❑ Other (If Other, please describe): <br />'The Special Events Committee may request proof of non-profit status. <br />Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />Girls on the Run is a 10-week program for 3rd-5th grade girls that culminates in a non-competitive, <br />untimed 5K run/walk event. <br />Date of Event Setup [mm/dd/yy]:OS/20/2023 Time: 5:00a.m. <br />Begin Date of Event [mm/dd/yy]: 05/20/2023 Time: Q-30 a rn <br />End Date of Event [mm/dd/yy]: 05/20/2093 Time: 1 2 nfl n m <br />Event Cleanup Completion [mm/dd/yy]:05f20/2.,A Time: 1 p.m. <br />Total anticipated attendance: 2500 <br />The proposed event will require the closing of: ©Streets ❑ Sidewalks <br />