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N <br /> Centerville <br /> Special Event Permit Application <br /> 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: W <br /> Cub Scout Pack 432 Rocket Launch 4 <br /> New Application: X Renewal of or Change in Application: <br /> CONTACT PERSON: Mr. Robert Nelson - Cubmaster Pack 432 <br /> TELEPHONE: 612)366 -5135 OR 651330 -3601 <br /> 2. IDENTIFYING INFORMATION: <br /> Attach a written communication from the organization(s) in whose name the event will be advertised which <br /> authorizes you, the applicant, to apply for this special event permit on its/their behalf. <br /> Applicant's Name: Robert Nelson Title: Cubmaster <br /> Address: 7164 Mill Road Centervilie,MN 55038 <br /> Mailing Address: Same <br /> Affiliation: <br /> Day Phone: (612)366 -5135 Evening Phone: (651)330 -3601 <br /> Emergency Phone: (651)321 -1901 <br /> 3. EVENT PRINCIPALS: <br /> Following, please list the names, addresses and telephone numbers of all the principals involved in any of the <br /> proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial <br /> sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the <br /> event is being advertised, and all others administratively, financially and organizationally involved as principals in <br /> the production of the proposed special event. Make additional copies of the following as needed to include as of the <br /> principals involved in the proposed special event. <br /> Name: <br /> Organization /Business/Agency /Affiliation: <br /> Is this a non - profit organization? Yes No <br /> If you are making application under non - profit status, proof of non - profit status must be attached to this application <br /> Mailing Address: <br /> Day Phone: Evening Phone: <br /> Title and functional responsibility with regard to the event: <br /> Page 1 of 10 <br />