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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 />• <br />-a�-a-s <br />Date: 5 <br />Applicant Signature: <br />• <br />0 <br />Printed Name: U ritJ4 14 B R d m e l l N <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Memb r <br />Member <br />Member <br />�/as/ah <br />Date <br />