Contact Information Event Organization * Primary Contact Person * Mailing Address * Phone * E-mail * Secondary Contact Person Secondary Phone Secondary E-mail Event Information Event Name * Location of Event * Date Requested * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Time Requested * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Event Description * Facilities Requested Materials to be brought on City property Special arrangements of equipment and facilities Anticipated Attendance Is there an admission charge? Yes No If yes, state amount Beneficiary Grand Stand Rental Required? Yes No If yes, number of days Run / Walk Events Desired route Route 1: Park Drive, North on 6th Street, West on Fuesser Road, South on County Road, East on Harnett Street, North on 10th Street, East on Park Drive to finish. Route 2: Park Drive, South on 6th Street, East on Harnett Street, South on Railway Street, West on Main Street, North on County Road, East on Harnett Street, North on 10th Street, East on Park Drive to finish. Alternate Route Alternate Route to be considered Attachments Event Flyer Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Proof of nonprofit status (if applicable) Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Proof of liability insurance in the amount of $1,000,000 naming the City of Mascoutah as additional insured Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Damage bond or cash deposit to protect city facilities in the amount of $500,000 Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. By signing below, the Applicant agrees to the rules set forth in Section 31- 7-2 (e) of the City of Mascoutah Code of Ordinances. Electronic Signature * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Leave this field blank