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tervi{{e 'Lsta6fi.sIieQ 18!>7 Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2008 "Fete des Lacs" New Application: x Renewal of or Change in Application: CONTACT PERSON: Greg Kieselhorst TELEPHONE: 651-653-1833 OR 612-221-9122 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: _Greg Kieselhorst Address: 7155 Brian Drive Centerville. MN 55038 Mailing Address: Same Affiliation: Centerville Lions Club Day Phone: _612-221-9122 Evening Phone: Emergency Phone: 612-221-9141 Title: Secretary 651-653-1833 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, fmancially and organizationally involved as principals in the production of the proposed special event. Make additional copies ofthe 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, Droofofnon-profit status must be attached to this application 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