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Centerville <br />Special Event Permit Application <br />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 worldwide. <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 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: Vice President ACRC <br />Address: 885 Orange St. <br />Mailing Address: Lino Lakes, MN <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 />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 and Emergency Services, Inc <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-Qofit status must be attached to this application <br />Mailing Address: PO 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 Coordinator is Tim Neu 651-366-0021 <br />Page 1 of 10 <br />15 <br />