Pickens Event Permit Application

Name of Company/Organization*

Name of Responsible Party*

First

Last

Address*

Street Address City State / Province / Region Postal / Zip Code

Email*

Phone*

Where Will Your Event Take Place?*

Main Street

Pickens Amphitheater

Other

If You Selected "Other", please describe.*

Select the Number of Hours You Are Requesting Use at the Pickens Amphitheater. Please note associated Fee Schedule.*

Does this organization have a 501(c)3 designation?*

Yes

No

Enter the active 501(c)3 Identification Number:*

Date(s) Of Event*

Hour(s) of Event*

Estimated Attendance Number:*

Describe your event:*

Names of other responsible parties involved:

Are you requesting the City sponsor this event?*

Yes

No

Please explain why you are requesting the City to sponsor this event?*

Attach Your Event Plans:

Attach Your Road Closure Map:

Attach Your Certificate of Liability Insurance:

Attach Your City of Pickens Business License:

Attach Your Alcohol License:

Proof of general liability insurance is required, naming the City of Pickens as an additional insured for this event. You may use the TULIP (Tenant Users Liability Insurance Program) program to purchase competitively priced insurance for this event. Go to www.ebi-ins.com/tulip and enter 0501-684 when asked for the Entity ID code. Answer the questions and you will receive a quote for this insurance. If you would like to proceed with purchasing the insurance, you may do so with a credit card. A Certificate of Insurance will be emailed to you and to the City of Pickens. For help, call 1-800-507-8414.

By submitting this application, I personally accept the responsibility to observe all regulations concerning the use of this facility. I affirm the information is accurate and to the best of my knowledge, I am authorized to sign as a representative of the organization. By electronically submitting this form, I affirm that the above information is correct.

Pickens Event Application