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City of South Bend Special Event Application <br />0 <br />' City and Regional Event <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />x <br />7l�65 <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Brina 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 Event <br />applications must be submitted more than 30 days in advance of the event date or the application will not be <br />accepted. <br />SectionA — A IicantInformation <br />Date of Application: 6 _ Organization Name: P L T 74 '. tdA. <br />Applicant (Contact) Name: G9 1 FH A / cAf <br />Applicant (Contact) Phone: 3 I I Gq q y V Contact Email: Ca, PRO L4 F'5 /q 1 d RC6 <br />Address: �()6q, I AbN v Oon CA 5iE: 130 City/State/ZIP: SOV 7b( BeNDo tN q g � 5 <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 />Contact Email: <br />City/State/ZIP: <br />