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2. Personal Information
   Please complete the following information.
4. Full Name*
6. Date of Birth*
   Date of Birth
7. Gender*

   1. Male
   2. Female
8. Race and Ethnicity*
   -- Select One --African American / BlackAmerican Indian or Alaskan NativeAsianHispanic, Latino/a, or SpanishMiddle Eastern or Northern AfricanNative Hawaiian or Other Pacific IslanderWhiteDecline to state
10. Organization
11. Non-Profit (501c3)

    1. Yes
    2. No
13. Email Address*
15. Address*
16. Apartment #
18. City*
19. State*
20. Zip Code*
22. Home Phone*
23. Cell Phone
25. Full Name of Contact Person on Day of Rental*
26. Phone Number of Contact Person on Day of Rental*
28. Rental Information
30. Event Type*
    What type of event are you having (ex. race, walk, run, etc.)?
32. Date(s) of Rental*
34. Set Up Time*
35. Event Start Time*
37. Where is the exact location the stage will be set-up on site?*
39. Event End Time*
40. Clean Up Time*
42. Will you be closing streets?*
44. Expected Attendance*
46. Will you have amplified sound?*

    1. Yes
    2. No
47. Will you have rides or inflatables?*

    1. Yes
    2. No
49. Will you be selling food?*

    1. Yes
    2. No
50. Will fees or donations be collected?*

    1. Yes
    2. No
52. How will you be advertising this event?*
54. Event Details
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field