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Date of Request:
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| Organization/Group: |
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| Representative/Primary Contact: |
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| Contact Phone: |
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| Contact Email: |
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| :: Event Information :: |
| Date(s) of the Event: |
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| Time(s) of the Event: |
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| Location of the Event: |
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| :: Purpose of Event :: |
| Goals/Rationale for event: |
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| Who is intended audience? |
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| Type of Event: |
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| This event is: |
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| :: Facilities Requested :: |
Please check all the facilities needed: |
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Does the request exceed normal Dixon hours? |
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| If yes, please list the hours. |
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| :: Equipment Available :: |
Please indicate quantity needed next to the equipment: |
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| :: Entries/Tickets :: |
| Deadline to Enter: |
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| Expected number of: |
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| Minors involved? |
Yes No |
| Waiver needed? |
Yes No If yes, please email (via attachment) a copy of the waiver for approval. |
| :: Additional Needs/Requests :: |
| Safety Staff: |
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| If yes, please list the hours. |
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| :: Food/Concessions :: |
Will there be any food sold or refreshments served? |
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