2005-05-25 Set Agenda - Laserfiche WebLink

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.. ~eMfte " 'Esta{i{is!ird l85l Centerville Special Event Permit Application L TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: 2005 "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 commUDication from the organization(s) in whose name the event will be advertised which authorizes you, the applicant, to apply for this speciaI event permit on itsitheir behalf. Applicant's Name: _Greg Kieselhorst Address: 7155 Brian Drive CenterviIle. MN 55038 Mailing Address: Same Affiliation: Centerville Lions Club Day Phone: _612-221-9122 Evening Phone: Emergency Phone: 612~221-9141 Title: Secretmy 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 speciaI event. Include professionaI 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 organizational1y involved as principals in the production of the proposed speciaI 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 OrganizationlBusiness/ Agency! Affiliation: Lions International Is this a non-profit organization? _X_ Yes No If you are making application under non-profit status, moof of non-nrofit status must be attached to this apnlication 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-oDS etc. Page 1 of! 0