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Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Anoka County Radio Club - Field Dav Excercise- This event is an emergency preparedness event where club members set up radios and antennas and practice information exchange with other groups world-wide. New Application: X Renewal of or Change in Application: CONTACT PERSON: Tim Neu TELEPHONE: 651-366-0021 OR 651-780-8009 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: Tim Neu Title: VP,Anoka County Radio Address: 885 Orange St. Mailing Address: Lino Lakes Affiliation: Anoka County Radio Club and emergency services, Inc Day Phone- 651-366-0021 Evening Phone: Same Emergency Phone: 651-238-8816 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 advertised, 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. Anoka County Radio Club Organization/Business/Agency/Affiliation. 50lc3 Organization(Tax ID 363470621) 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 application Mailing Address: P.O Box 982 Anoka, MN 55303 Day Phone: 651-366-0021 Evening Phone- 651-366-0021 Title and functional responsibility with regard to the event: Participant in the ARRL field day excercise-http://www.arrl.org/field-day/ Event Coordniator is Tim Neu 651-366-0021 Alt Contact- Bob Cordell - 612-275-2354 Alt Contact- Shawn Rung- 763-238-7580