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TN a City of South Bend Special Event Application <br />City and Regional Event <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. City and Regional Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: 3 Idea -3/� Organization Name: S� - i>a q ��J�� T G�_r11411 <br />Applicant (Contact) <br />/sc <br />Applicant (Contact) Phone: 9 74— 41-'5_70$ ContactEmail: pClflS+Ps?C/E' �i S�g�al berE <br />School. <br />Address: 0'1�� w G�f Sf City/State/ZIP: SO C4 / n o `1,,6 6 /9 Ur <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 I�Yevent. <br />Organization r — <br />Organization Name: ' S/r+iii PGi(YContactName: PC/ 1—?IC,IVq <br />Contact Phone: <br />S 741 g— SJu 9 Contact Email: JQ4 ig, wca <br />Address:`��V s w' 62mce St- City/State/ZIP: <br />Section B - Event Information <br />C �� P� as4Toh <br />Event Name: UrP� S it s. Event Type: Race, Parade, Other): <br />P" cc SS,o•. <br />(Festival, <br />Event Classification: 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 <br />H of this <br />application. The description should be a summary overview.) Ve f.✓//[ PYUCPSS <br />W,4-4 <br />} BltsSpeeSGCStea/%P.f <br />St' C�14I/hte- rG/ts4 , <br />Date of Event Setup [mm/dd/yyl: 0 ra / // l a -3 Time:n <br />Pc /Il b 3 ids P ✓� <br />Begin Date of Event [mm/dd/yyl: Time: <br />�2/ <br />End Date of Event [mm/dd/yyl: 06 I Time: / 3 P)' <br />/g3 <br />• Event Cleanup Completion [mm/ddd/yyl: 0 6 / / / 47-L3 Time: r 7ti <br />Total anticipated attendance: o[ U o <br />The proposed event will require the closing of: X Streets J Sidewalks <br />