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n; City of South Bend Special Event Application <br />d City and Regional Event <br />-4 la <br />!@ $50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />e'5 <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Bring 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: G-�%2`9 Organization Name:) iA*,j Gyoc� <br />Applicant (Contact) Name: (-::�p <br />Crr_ AfAiJa , <br />Applicant (Contact) Phone: t� �fi f S ' 4 ContactEmail:Cf r _ ' , 01 <br />Address: � /61 'k-LM �Wt� City/State/ZIP: CDr)�hl�lnr� ��j y�Q�p UX <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. X /A <br />Organization Name: <br />Contact Phone: <br />• Address: <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />y `' I 7� / 'SLe'ction B - Event Information <br />Event Name: YV>iS1k ffia-- �f!'..dl �61 Event Ty (Festival, ace, Parade, Other): <br />Event Classification:X Non -Profit' ❑ For -Profit <br />❑ City (Civic) Sponsored 0 Other (If Other, please describe): Wit, l xr -As u u�c �j J ICdrJ <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 H of this <br />application. The description should be a summary overview.) <br />Date of Event Setup [mm/dd/yy]: 0-7 /ZS�%Z-24 Time: 0 t <br />Begin Date of Event [mm/dd/W : 6-7 /P-8 / Zy Time: 1 I R <br />o� �2�-t <br />End Date of Event [mMdd/yy]: � � Time: <br />Event Cleanup Completion [mMdd/yy]: 0-7 2L4 Time: " A M <br />• Total anticipated attendance: N-/'N tO 0 <br />The proposed event will require the closing of Streets ❑ Sidewalks <br />