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Attendees <br />Name: Rhone: <br />Name: Phone: <br />Name: <br />.Name: <br />Phone: <br />Phone; <br />.Name: Phone; <br />Naive: Phone: <br />J/%ve acknowledge that t/we understand and Will adhere to the attached policies <br />Applicant Signature: Date: <br />,Data Prgetiees AdvisoaI—Teuncssen Warning) <br />t understand .that some of-ihe information provided*on-this form will be pulilicodata. Public data is available to anyone who makes a <br />request for such information. Under.the Mitineso.ta Data Practices Act, your address, email and/or telephone number are private data. <br />You -may choose notrto.provide some or all of this private data., but it may cause your Heritage .Elall Rental request to be denied. By <br />completing this information; you axe; consenting to allow the City of Germ Lake staff to share -this information in order.to administer <br />Gent Lake Policies regarding Heritage fiall:Rental Reservations. Please sign below to. affirathatybu.have read thin--ttotice.. <br />Applicant Signature; <br />Date: <br />r <br />I <br />Office Use Only. <br />:Approved: [I Yes 0 No Tfno, reason: ff <br />Assigned Counciltneimber., <br />Amount Paid: ©. Cash © Check Checic # (if applicable): <br />Heritage ElalI Rental Application Rago:2 of <br />