2009-06-10 CC Packet - Laserfiche WebLink

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c~~ Centerville Sp~ial Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2009 "Fete des Lacs" New Application: _X_ Renewal of or Change in Application: CONTACT PERSON: Greg KieseIhorst TELEPHONE: 612-221-9122 OR 612-221-9141 2. IDENTIFYlNG lNFORMATION: 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 itsltheir behalf. Applicant's Name: _Greg KieseIhorst Address: 7155 Brian Drive Centerville. MN 55038 Mailing Address: Same Affiliation: CentervilIe Lions Club Day Phone: _612-221-9122 Evening Phone: Emergency Phone: 612-221-9141 Title: Lion 612-221-9122 3. EVENT PRINCIPALS: Following, please list the names, addresses and telephone numhers 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, financially and organizationally involved as principals in the production of the proposed special event. Make additional copies of the following as needed to include as of the principals involved in the proposed special event Name: Centerville Lions Club Organization/Businessl Agency! Affiliation: Lions International Is this a non-profit organization? _X_ Yes No If you are making application under non-profit status, Droof of non-Drofit status must be attached to this lIPDlication 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 Chairperson, as part of said duties permit applications and insurance add-ons etc. Page 1 of 10 23