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;lizg'rcv Centerville <br /> Special Event Permit Application <br /> 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Festival of Lakes Skate/Run/ <br /> Walk <br /> New Application: X Renewal of or Change in Application: <br /> CONTACT PERSON: Pat Branch, Chair Parks & Recreation Committee <br /> TELEPHONE: 703 -501 -6815 OR <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: Pat Branch Title: Chair <br /> Address: 1618 Hunters Ridge Lane <br /> Mailing Address: Same as above <br /> Affiliation: Parks & Recreation Committee Chair <br /> Day Phone: Same as above Evening Phone: <br /> Emergency Phone: <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: Parks & Recreation Committee <br /> Organization /Business /Agency /Affiliation: Local Businesses Sponsors <br /> Is this a non -profit organization? Yes X 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 />