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I have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of <br />• the information provided by me to the best of my knowledge. I understand and agree to the above rules <br />and regulations. and any applicable state and federal laws. I also understand that this application may be <br />denied based on any false or incomplete information. <br />Date: O S l O q( as O a 3 <br />Applicant Signature <br />Printed Name: moo'+',,A `N <br />esi n[ <br />i <br />• Member <br />is <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Me er c I ^ <br />N , <br />Member <br />Member <br />Date <br />