2013 special event permit application - Chicago Park District

2013 SPECIAL EVENT PERMIT APPLICATIONINSTRUCTIONS: Please carefully read the “Event Rules and Regulations” (pages 6 through 9) and “Fee Schedule” (page 10) sections beforecompleting this application. Incomplete applications and/or applications without the required application fee will not be processed.APPLICANT INFORMATIONACTIVE NET CUSTOMER NUMBER:NAME OF APPLICANT/EVENT ORGANIZER/PRODUCER (same as individual’s name listed inSignature section on page 21)DATE OF BIRTHMO/DAY/YEARGENDERMALEFEMALEDRIVER’S/STATE ID#STREET ADDRESS/APT/UNIT/SUITE CITY STATE ZIP CODEE-MAIL ADDRESS DAYTIME PHONE FAX CELL PHONEEMERGENCY CONTACT NAMEEMERGENCY CONTACT ORGANIZATIONE-MAIL ADDRESS DAYTIME PHONE FAX CELL PHONEEVENT DAY ON-SITE CONTACT (if different from Applicant) DAYTIME PHONE CELL PHONEEVENT SPONSOR: Are you, the applicant, organizing this event on behalf of another organization? (Defi nition located on page 11).(Please check NO or YES below. If YES, please provide additional information as requested below. If NO, please skip to Event Information section below.)NO YES 2 Name of Organization 2 :SPONSORING ORGANIZATION CONTACT NAME (if applicable)SPONSORING ORG. CONTACT PHONEADDRESS OF SPONSORING ORGANIZATION (if applicable) CITY ZIP CODE2Additional Documentation Required: If you checked “YES” above, please submit an endorsement letter from the organization (on their officialletterhead) on whose behalf you are organizing this event.The Chicago Park District is interested in learning more about park users. Please select which age group best describes your event participants/spectators.(Responding to this question is optional.)Youth (0-17) Young Adult (18-34) Adult (35-59) Seniors (60+) All Ages/FamilyEVENT INFORMATIONEVENT NAME NUMBER OF PARTICIPANTS NUMBER SPECTATORS1ST CHOICESET-UP DATE(S) EVENT DATE(S) TEAR-DOWN DATE(S) PARKSET-UP TIME EVENT TIME TEAR-DOWN TIME SPECIFIC LOCATION2ND CHOICESET-UP DATE(S) EVENT DATE(S) TEAR-DOWN DATE(S) PARKSET-UP TIME EVENT TIME TEAR-DOWN TIME SPECIFIC LOCATION3Additional Information Required: If your event includes multiple locations, days and/or varying times, please attach a schedule.DEPARTMENT OF REVENUE541 North Fairbanks Court, 4th Floor | Chicago, IL 60611 | Phone (312) 742-5369 | Fax (312) 742-6038 | www.chicagoparkdistrict.com