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/y T City of South Bend Special Event Application <br />d City and Regional Event <br />• V .. PCACL (� <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />ier5 / <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: 5/,30/ � � Organization Name: Ur l i4 G crck s 1 Y"c <br />Applicant (Contact) Name: o—r - �� ✓ <br />Applicant (Contact) Phone: �' f � _ Contact Email: 8Lf=42 T VU V r` ,t r 6 (,r(, n s - On <br />Address: PfQnt �iyri. S0 City/State/ZIP: CXx �,r) <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 events' <br />Organization Name: <br />1-1f) l,�c rda/�S AL Contact Name: <br />Contact Phone: 9_iJ� 508 S 1-a Y Contact Email: <br />• ] C S� o�Z w <br />Address: �-1y.bQ Z. City/State/ZIP: <br />Section B - Event Information <br />IVC <br />Event Name: �N PSt [5;�` 1a1�Q' li+� Event Type: (Festival, Race, Parade, Other): ?C i LA <br />G�c—►sC Qs G—FI'(f)r� ACF <br />Event Classification Non -Profit` ❑ (�ZtAKUM'C"i For -Profit cl,LXjttiH THAT iStN6S POW, <br />❑ City (Civic) Sponsored X Other (if Other, please describe): Mast C. , qf_ W6yf L W5 TO 77f6 WC57' <br />SIDE OF 59 6*JfL('&#4"M5 OL1? <br />`The Special Events Committee may request proof of non-profit status. VU L Gftftlu4L3V0 I <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 />oy ZZZ 7AIA <br />Date of Event Setup [mm/dd/yy]: Time: <br />//a-3 <br />Begin Date of Event [mm/dd/yy]: O -7 a•-i 12_3 Time: I <br />I * I-, <br />End Date of Event [mm/dd/yy]: CO /;;-3 �?5 Time: <br />14 P' <br />b, /�3 <br />PM <br />Event Cleanup Completion [mm/dd/yy]: Time: <br />i_4 <br />• Total anticipated attendance: " � n CQ <br />The proposed event will require the closing of: Streets 0 Sidewalks <br />