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<br />(i~~~ <br /> <br />Centerville <br />Special Event Permit Application <br /> <br />1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2008 Centerville and Lino <br />Lakes Lions Ice Fishing Contest <br /> <br />New Application: _X <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: Greg Kieselhorst <br />TELEPHONE: 612-221-9122 <br /> <br />OR 651-653-1833 <br /> <br />2. IDENTIFYING INFORMATION: <br /> <br />Attach a written communication from the orgilni7.ation(s) in whose name the event will be advertised which <br />authorizes you, the applicant, to apply for this special event permit on itsltheir behalf. <br /> <br />Applicant's Name: _Greg Kieselhorst <br />Address: 7155 Brian Drive Centerville.. MN 55038 <br />Mailing Address: Same as above <br />Affiliation: Centerville Lions Club <br />Day Phone: _612-221-9122 Evening Phone: <br />Emergency Phone: 612-221-9141 <br /> <br />Title: Lions Secretary <br /> <br />651-653-1833 <br /> <br />3. EVENT PRINCIPALS: <br /> <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 organi7~0n(S) in whose name the <br />event is being advertisecL and all others administIatively, financially and organi7~onally 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 /> <br />Name: Centerville Lions and Lino Lakes Lions Clubs <br />OrganizationIBusinessl Agency/Affiliation: Volunteer Organization <br /> <br />Is this a non-profit organization? <br /> <br />X Yes <br /> <br />No <br /> <br />If you are making application under non-profit status, proof of non-orofit status must be auached to this ~pplicatibn <br />.Should be on file with the City of Centerville from the Minnesota Secretary of State, if not it will be provided. <br /> <br />Mailing Address: Same as ,hove Day <br />Phone: Same Evening Phone: Same <br />Title and functional responsibility with regard to the event: Centerville Lions Secretary. As part <br />of said duties, event permits and Lion insurance add-ons etc. <br /> <br />Page 1 of 10 <br /> <br />0/ <br />