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TvuiG <br /> Centerville <br /> Special Event Permit Application <br /> 1. TITLE,PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Anoka County Radio Club - <br /> Field Day Excercise - This event is an emergency preparedness event where club members set <br /> up radios and antennas and practice information exchange with other groups world-wide. <br /> New Application: X Renewal of or Change in Application: <br /> CONTACT PERSON: Tim Neu <br /> TELEPHONE: 651-366-0021 OR 651-780-8009 <br /> 2. IDENTIFYING INFORMATION.- <br /> Attach <br /> NFORMATION: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: Tim Neu Title: VP,Anoka County Radio <br /> Address: 885 Orange St. <br /> Mailing Address: Lino Lakes <br /> Affiliation: Anoka County Radio Club and emergency services, Inc <br /> Day Phone: 651-366-0021 Evening Phone. Same <br /> Emergency Phone: 651-238-8816 <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 Anoka County Radio Club <br /> Organization/Business/Agency/Affiliation: 5016 Organization(Tax ID 363470621) <br /> Is this a non-profit organization? X 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: P.O. Box 982 Anoka, MN 55303 <br /> Day Phone, 651-366-0021 Evening Phone: 651-366-0021 <br /> Title and functional responsibility with regard to the event: Participant in the ARRL field day <br /> excercise-http://www.arrl.org/field-day/ Event Coordniator is Tim Neu 651-366-0021 <br /> Alt Contact- Bob Cordell - 612-275-2354 <br /> Alt Contact- Shawn Rung- 763-238-7580 <br /> / / <br />