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^J T R\J City of South Bend Special Event Application <br />City and Regional Event <br />• Y. ,•.;r h <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if fA!d 30-59 days in advance of event <br />Please Brine Completed Application and Payment to: <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 />Section A- Applicant Information �1 n ,7 <br />Date of Application: cYi/O3n Organization Name: SL- i'7 dg,140, Ayr, y e <br />Applicant(Contact)Name:-Fr- PL4Q'n J-rg/pZroL,,J,,, <br />Applicant (Contact) Phone: J T�' � 7y�Contact Email: I Q�wc/"VrAk rif7J IbCtt.fo� <br />olJUS W' 621-aW S'� S W P: d'. /Y S gri�a� f`fSti�deJ. <br />Address: City/State/ZIP:—DN n <br />5`6C/9 <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. t n <br />Organization Name: ?Z J �� 7�/(t Contact Name: -/ eL4CYh f1'pClem0S <br />Contact Phone: a� s7V Contact Email: 4L4qh @ �c1CgSGiOr[��%� i5 +at? • d <br />• Address: �25d5' ti/ 6�a Sf . City/State/ZIP: St)>A4K 460jel Div 9 <br />57q-.2-7G-619s <br />Event jnformation <br />Event Name: In/nCo /Fl4/nyPe:(Festival,Race, Parade, Other) e'7/- <br />Event Classification: 0 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 Hof this <br />application. The description should be a summary overview.) <br />Date of Event Setup [mm/dd/yy]: 05106 /V9 Time: O i U U C/ pn <br />Begin Date of Event [mm/dd/yy]: Q 5-/0(o / ,V 3 Time: , 0 a 122n <br />End Date of Event [mm/dd/yy]: o5-j06 /' 3 Time: S , U L) P /&-� <br />® Event Cleanup Completion [mm/dd/yy]: d 5 /0 6 h3 Time: —7. <br />Total anticipated attendance: �lOo 8 <br />The proposed event will require the closing of: O Streets IKSidewalks <br />