Special Event Request

FORM ID

First Name

Last Name

Organization Name

Telephone

Event Type

Date of Event

Start Time

End Time

Route / Area of Event

Who will be obtaining the PENNDOT Permit? (if applicable)

Will fire police be required for traffic control?

Yes

Who has the banner?

Telephone

When does the banner need to be put up

Other Information

Disclaimer

All special events must be approved by Borough Council one month before the event is to take place. Coudersport Borough must receive a copy of the PennDOT approval before the event will take place

Signature

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SPECIAL EVENT REQUEST

Borough of Coudersport