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2. Special Event Application
4. Date of the event:*
   Date of the event:
5. Event starts at:*
   Event starts at:
6. Event ends at:*
   Event ends at:
8. Name of Applicant*
10. Organization*
12. Name of Event*
14. Event location:*
16. Event Summary/Description*
    (This is to include the location of the event, list of the route if a road race, number of people expected for the event, detour routes, and any other information that would be helpful for responders.)
18. Event Contact Name:*
    Authorized and Responsible Person(s) in Charge
19. Email Address*
21. Phone Number*
23. Secondary Contact Name*
24. Email Address*
26. Phone Number*
28. Is this a public or private event?*

    1. Private
    2. Public
30. Will you need any assistance from the services listed below?*

    (Please check all that apply)

    1. None
    2. Emergency Medical Services (EMS)
    3. Fire Department

    1. Law Enforcement
    2. Office of Emergency Management (OEM)
32. Are you requesting to close a road?*

    1. Yes
    2. No
34. If yes, name of the road:*
    Please indicate the name of the road that will be affected and if this is a full or partial closure.
36. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
38. Electronic Signature*
40. Signature of Police Agency
    Official Use Only
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field