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<br />~= <br /> <br />Centerville <br />Special Event Permit Application <br /> <br />1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2006 Centerville Lions Easter <br />Egg Hunt <br /> <br />New Application: _X <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: Greg Kieselhorst <br />TELEPHONE: 612-221-9122 <br /> <br />OR 651-653-1833 <br /> <br />2. IDENTIFYING INFORMATION: <br /> <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 /> <br />Applicant's Name: _Greg Kieselhorst <br />Address: 7155 Brian Drive Centerville. MN 55038 <br />Mailing Address: Same as above <br />Affiliation: Centerville Lions Club <br />Day Phone: _612-221-9122 Evening Phone: <br />Emergency Phone: 612-221-9141 <br /> <br />Title: Lions SecretarY <br /> <br />651-653-1833 <br /> <br />3. EVENT PRINCIPALS: <br /> <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 /> <br />Name: Centerville Lions Club <br />OrganizationIBusiness/ Agency! Affiliation: Volunteer Organization <br /> <br />Is this a non-profit organization? <br /> <br />_X_ Yes <br /> <br />No <br /> <br />If you are making application under non.profit status, proof of non.profit status must be attached to this awlication <br />.Should be on file with the City ofCenterville from the Minnesota Secretary of State, ifnot it will be provided. <br /> <br />Mailing Address: Same as above Day <br />Phone: _Same Evening Phone: Same <br />Title and functional responsibility with regard to the event: Centerville Lions Secretary. As part <br />of said duties, event permits and Lion insmance add-ons etc. <br /> <br />Page 1 of10 <br />