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City of South Bend Special Event Application <br />r City and Regional Event <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />Mass �. <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 wil I not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application. Organization Name: 17 i etii <br />Applicant (Contact) Name: ccnn Q PXSO 1 <br />Applicant (Contact)Phone:�`1,3-�I�J ContactEmaii:Ar" a -��aj• •UJ <br />Address: AIM S . FO,UV(dX S1 City/State/ZIP: S Z h �-Q ►✓ <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 />Contact Name: <br />City/State/ZIP: <br />Section B - Event Information <br />Event Name : �cCrVlJ4iA[ �/wf �� <br />_ Event Type: (Festival, Race, Parade, Other <br />,iy �� <br />Event Classif ication: 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: 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]: " LO 12 , ZZ( Time: Q 00 <br />Begin Date of Event[mm/dd/yy]: 01 )ON Time: /t1lt� <br />End Date of Event [mm/dd/yy]: �Q� V)n 30 Time: � 9 - "l - <br />EventCleanupCompletion[mm/dd/yy]: _) Time: <br />isTotal anticipated attendance: 3f ! , 1-- e <br />The proposed event will require the closing of: Streets El 112 it 1 i On ( `1ireo <br />