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PUBLIC WORDS DEPARTMENT <br />PARKS AND OPEN SPACE DIVISION <br />1. Date: `' <br />2. <br />3. <br />4. <br />5. <br />Name and Type of <br />INTER- DEPARTMENTAL <br />PARK RESERVATION FORM <br />from `� 0o to ! 0 0 <br />a� set -ul?, take -flown, §e�clean <br />Date(s) of Event: I n Time: <br />(Inclu <br />a. Requested park, open space, or park facility (be specific): <br />b. Brief Description: <br />Department/Division: <br />Contact Name: C14 & &- <br />Phone: � ,� E -Mail Address: <br />6. Name of Non -City Partner (if applicable) : <br />Contact Name: tx 4 0 Telephone Number: -- `7 <br />t <br />7. a. Will food be served at your event? Yes ee Mote) <br />b. Will alcoholic beverages be served at your event? see note) o <br />c. Will you need to erect any type of tent or other stme re r your eve . Yes (see note <br />d. Will your event include amplified sound for more than two hours? Yes (see note) III o <br />e. Estimated Attendance: C 1 n r "N <br />Public Works Department <br />CP Z <br />Parks and Open Space Division' <br />Internal Use <br />The reservation is: fending; additional information is needed ccepte Cannot Be Accepted <br />*All Park and Open apace Rules Applies <br />Comments: <br />Reviewed by: Dated <br />7a: May need certificate from Lane County Environmental Health <br />7b: May need alcohol liability insurance <br />7c: May need site plan <br />7d :. May need schedule of entertainment <br />P:I Finance& AdininTarkRentall nformationl FormslCurrent \fntema[ReservationFomiUpdated 11- 2012.doc <br />