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<br />Apr 24 09 08:29a <br /> <br />Catharine Branch <br /> <br />703-323-4964 <br /> <br />p.l <br /> <br />~ <br /> <br />Centerville <br />Special EveDt Permit Application <br /> <br />I. <br /> <br />TlTLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: <br />{';'-S-nV/{L 'F flk. tAhlS f I<. RvlV / wlJ(../( <br />~ ,,::t.N J ttKS bYM' <br /> <br />New Application: <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: PllTtel ~ /YeAAJC/I <br />TELEPHONE, 7'U Sol 6rfS (coaf OR <br /> <br />2. IDENTIFYING INFORMATION: <br /> <br />Attach a written communication from the organization(s) in whose name the event will be advertised wbich <br />authorizes you. 1hc applicant, to apply fo,this special event permit on itsltheir behalf. <br /> <br />Applicant's Name: /=#T7?IC.1< K, (J(I'/A)c!f Tille: /(Jk.t! (JJRi:'t1tJf <br />Address: j(;,/f( #U~ ,fl,he. t..'1"'. <br />Mailing Address: ee."rtn "" tu - 1If;z) S3'"0:J8 <br />Affiliation: Ct::)Jftfrt 1/1 Uc P.hfKS 11..0 /((fU'cr'H'l1JN CO'''!,.., 'IT'vJ: <br />Day Phone: 703 ;'1 6'(/s Evening Phone: <br />Emergency Phone: <br /> <br />3. EVENT PRINCIPALS: <br /> <br />Fnllowing, please list lbe names, addresses and lelepbone numbers of all the principals involved in any of the <br />proposed special evenL tnclude professional event ocganizers. event promoters, financial undeTWTiters, commerciaJ <br />sponsors, charitable agencies for whose benefit the eveot is being produced. the OI'ganization(s) in whose name the <br />event is being advertised, and all others administratively, financially and ocganizationally involved as principals in <br />the production of the proposed special evenL Make additional copies of the following as needed to include as oftbe <br />principals involved in the: proposed special event. <br /> <br />Name: Ct 1y 07 Cc",f(r 11" /La P4il k itN/) 1l..r:J(li'fl'nJW <br /> <br />OrganizationIBusinessi Agencyl Affiliation: <br /> <br />Is this a non-profit organization? <br /> <br />---L- Yes <br /> <br />No <br /> <br />If you are making application undc< nor>-profit status, oroof ofnon-1>rof'n status must be attached to this lIDDlieation <br /> <br />Mailing Address: <br />Day Phone: Evening Phone: <br />Title and functional responsibility with regard to the event: <br /> <br />Page J of 10 <br />