2011-03-09 CC Packet - Laserfiche WebLink

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� �`�',-- ' ter�iCCe ' �� Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRTEF DESCRIl'TION OF EVENT: 2011 Centerville Lions Easter Egg Hunt New Application: X Renewal of or Change in Applica.tion: CONTACT PERSON: Greg Kieselhorst . TELEPHONE: 612-221-9122 OR 2. IDENTIFYING INFORMATION: Attach a written communication from the organization(s) in whose name the event will be advertised which authorizes you, the applicant, to apply for this special event permit on its/their behalf. Applicant's Name: Greg Kieselhorst Title: Lion President Address: 7155 Brian Drive Centerville, MN 55038 Mailing Address: Same as above Affiliation: Centerville Lions Club Day Phone: 612-221-9122 Evening Phone: Same Emergency Phone: 612-221-9141 3. EVENT PRINCIPALS: Following, please list the names, addresses and telephone numbers of all the principals involved in any of the proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the event is being adverkised, and all others administratively, financially and organizationally involved as principals in the production of the proposed special event. Make additional copies of the following as needed to include as of the principals involved in the proposed special event. Name: Centerville Lions Club Organization/Business/Agency/Affiliation: Volunteer Organization Is this a non-profit organization? X Yes No If you are making application under non-profit status, proof of non-profit status must be attached to this atmlication *Should be on file with the City of Centerville from the Minnesota Secretary of State, if not it will be provided. Mailing Address: Same as above Day Phone: Same Evening Phone: Same Title and functional responsibility with regard to the event: As part of said duties, Event Permits and Lion Insurance add-ons etc. Page 1 of 10 12