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<br /> <br />Centerville <br />Special Event Permit AppHcation <br /> <br />1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2007 "Fete des Lacs" <br /> <br />New Application: _X_ <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: Greg Kieselhorst <br />TELEPHONE: 651-653-1833 . <br /> <br />OR 612-221-9122 <br /> <br />2. IDENTIFYING INFORMATION: <br /> <br />AUac:h a written c:oJ1IUH...GliOJl ftom the OJg,...i~aljOll(S) in wIIose name the event wm be adverdsed WIdch <br />authorizes you. the applicant, to apply for this special event permit on itsItheir bebaJ( <br /> <br />Applicant's Name: _Greg Kieselhorst <br />Address: 7155 Brian Drive Centervi1Ie. MN 55038 <br />Mailing Address: hme <br />Affiliation: Centerville Lions Club <br />Day Phone: _612..221-9122 Evening Phone: <br />Emergency Phone: _612-221-9141 <br /> <br />Title: ~ <br /> <br />651-653-1833 <br /> <br />3. EVENT PRINCIPALS: <br /> <br />FoUowing, please list the names, addresses and telephone DUIIIbeIs of aD the pri~lR involved in auy of the <br />ploposed special oveDt. I:ocludo p.....9---.;fmud event OJ'8P'Ii7mI;. event ~ ,,~, UDderwriters. cx.n.merdal <br />sponsors, charitable agencies for whose benefit the event is being produced, the Of81JnMdinn(s) in whose name the <br />event is being adwdised, ami aU others $.41a.;.~..;vely, tilUlftdAlly and orvihridiona1ly involved as f)li..elplk in <br />the production of the pJoposed special event. Make additimml copies of the following as needed to include as of the <br />princllJ8ls involved in the pI~ special event. <br /> <br />Name: Centerville Lions Club <br />Orpni7.8fionlBusinessl Agencyl AftUiation: lions Tnternatinnal <br /> <br />Is this a non-profit orgllni7.8tion? _X_ Yes <br /> <br />No <br /> <br />If yOUR makiJIg appJication UDdernon-pJOfit status, vmofof~ ld1dmZ nmst \M= ~ to this ~ <br />Non-Profit status should be a file, otherwise it will be provided. <br />l\Ia.iling Address: SAme <br />Day Phone: _Same Evening Phone: Same <br />T1tle and tbnctional responsibility with regard to the event: Lions Secretary, as part of said <br />duties permit appliamons and insurance add-ons etc. <br /> <br />Page IorIO <br /> <br />Z3 <br />