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Q4�,rn,�M City of South Bend Special Event Application <br />0 <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-Aoplicant Information <br />Date of Application: 12116-11a" b Organization Name: IQi fld -lb- L' A-4->na, /nc <br />Applicant (Contact) Name: NTD+Jla /1.9RC0l <br />Applicant(Contact)Phone: S'i33 Contact Email: Gxfcu?�vCD/RC«o,P .0 <br />"VOL FC •fici/p vw. OR 4 <br />Address:.200q 1A&,jwooL elec44r- City/State/ZIP: 5*�w Bn.,o /&I 4/6635- <br />50,7c /30 <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 />• Address: <br />• <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />✓ Section B - Event Information <br />Event Name: / rARcN 'OR F--' - jo vw bby.PEvent Type: (Festival, Race, Parade, Other): 44'e(w <br />Event Classification: ,LJ^,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: Adetailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />MARGr7 Po✓oTov-i 5&v,w SEND jvrlo—CD 6y 13R/!G PE446-F✓4 PROTES%- <br />Date of Event Setup [mm/dd/yy]: QI /14?1/ Time: 11 ` 30 AH <br />Begin Date of Event [mm/dd/yy]: 01111124 Time: /.2-'DO ;M <br />End Date of Event [mm/dd/yy]: 61111144 Time: /' 00 AM <br />Event Cleanup Completion[mm/dd/yy]: 01//1Time: /'4S M <br />Total anticipated attendance: 9/00 - (00 <br />The proposed event will require the closing of: ❑ Streets ❑ Sidewalks <br />