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' City of South Bend Special Event Application <br />d City and Regional Event <br />y,_ ETC2 7Z) <br />• \ " �! s aj $50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Brine Completed Apol0cat ion 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 will not <br />be accepted. <br />/ Section A - Applicant Information <br />Date of Application: // .organization Name'!5z / iuu.lb <br />Applicant (Contact) <br />Applicant (Contact) Phone: <br />Address: <br />List any professional event organizer, event service provider or commercial fundraiser that is authorized to work <br />on your behalf to pl n, produce yWor manage your event. I ,L//� <br />Organization Name. ✓ Conttaact Name:// / ✓ �,7107 <br />Contact Phone: 5?Y_69"a Sa. lY�i Contact Email:(9/ZA L/U,-,� d QU�agdf�iff <br />Address: C9. (1) . (� �5V_ City/State/ZIP: SUA &Wd -;;l1/ y2(xa <br />,I YP lr L <br />Event Name f� e t T e: estrva ,Race, Parade, Other):_o 2k[ <br />Event Classification: %NZZW•Noon-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. TpV descri ion should be a summary overview.) e <br />-FM urner P� - trd ad <br />Par, �6 <br />Date of Event Setup [mm/dd/yy]: � 6a j7w Time: 7 :3 d P /4' <br />Begin Date of Event [mm/dd/yy]: /�� �'� 0 2f Time: sJ eX D• A4 - <br />End Date of Event [mm/dd/yy]: �a� Q/ 9V 9V Time: ce..ail, PM <br />Event Cleanup Completion [mm/dd/yy]:W� /aZ a0 Time: 1A s, 3U Q- M. <br />411 Total anticipated attendance: <br />The proposed event will require the closing of Streets gSidewalks <br />