2015-05-13 CC Packet - Laserfiche WebLink

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CteryiCCe Embfis(ed hos, Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2015 Centerville Days /"Fete des Lacs" New Application: X Renewal of or Change in Application: CONTACT PERSON: John N. Thill TELEPHONE: Home 651-653-4641 OR: Cell 651-278-5097 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: John N. Thill Title: Centerville Lion President Address: 1375 Mound Trail, Centerville MN 55038 Mailing Address: Same Affiliation: Centerville Lions Club Day Phone: 651-653-4641 Evening Phone: 651-653-4641 Emergency Phone: Cell 651-278-5097 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: Centerville Lions Club Organization/Business/Agency/Affiliation: Lions International 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 aQplication Non-Profit status should be on file, otherwise it will be provided. Mailing Address: Same Day Phone: _Same Evening Phone: Same Title and functional responsibility with regard to the event: Lions Secretary, as part of said duties permit applications and insurance add-ons etc. Page 1 of 10 21