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11 <br />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 />Ll <br />�J <br />Date:_/�.3/� aS <br />Applicant Signature: <br />Printed Name: _ A�(rLV L� Moss <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Mem <br />Member <br />Date <br />