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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 />C1 <br />U <br />Date: y17— y/ZS <br />Applicant Signature: !v ( '/�— <br />Printed Name: 14an najA- Qefo = 4-b <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Mem <br />T"M-1I T <br />�//Y /;? 5 <br />Date <br />