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i <br />City of South Bend Special Event Application <br />2` 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 Brin¢ 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 />Date of Application: <br />Applicant (Contact) <br />Section A - Applicant Information r <br />�-/V -23 Organization Name: Prph Povr-k tao,,W <br />nyr„ <br />Applicant (Contact)Phone: r7y-2d%- <br />(p72y Contact Email:T��[tmo�r�.4N <br />Address: 123 At 1WA <br />City/State/ZIP: ' 6A <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 />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />Section B - Event Information <br />Event Name: 8'-/ -n.-da10D 4 Event Type: (Festival, Race, Parade, Other): Mkt ic <br />Event Classification: ❑ Non -Profit' M For -Profit <br />❑ City (Civic) Sponsored % Other (If Other, please describe): SYDK SOa»jo^_e of <br />`The Special Events Committee may request proof of non-profit status. <br />Provide a brief description and timeline of event (Note: Adetailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />r/MQfJ /i/94� IMYi, i` y/o vG1oGgi��i+ao I, F/1�/icJA�L.7�u yfar wC <br />h.&y 0.//�sui.'r'C.f wjA /tAea-rn Ufc ;(t,,wi 47tt jteeA) ', are flu? 4f V <br />Date of Event Setup [mm/dd/yy]: 09.A,/ Z3 Time: 2 �M <br />Begin Date of Event [mm/dd/yy]: � I4 /Z3 Time: 5- <br />End Date of Event [mm/dd/yy]: O 8�/(C 12-S Time: p/h <br />Event Cleanup Completion[mm/dd/yy]: Or4lllnW Time: M <br />• Total anticipated attendance: �00) " �%� <br />IF <br />The proposed event will require the closing of: 9Streets ❑ Sidewalks <br />