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2. Name of Event:
4. Date(s) and Time(s) of Event:
   Date(s) and Time(s) of Event: Start Date

   Date(s) and Time(s) of Event: Start Time

   —

   Date(s) and Time(s) of Event: End Date

   Date(s) and Time(s) of Event: End Time

   These dates and times must include all set up and clean up.

6. Organization:
7. UBI Number of Organizer
9. Name
10. Email Address
12. Address
14. City
15. State
16. Zip Code
18. Phone Number
20. Approximate Attendance:
22. Event Sponsor?

    1. Yes
    2. No
23. Name of Event Sponsor
25. Vendors?

    1. Yes
    2. No
26. How many vendors

    This includes all vendors selling products at the event. Fill out supplemental vendor form, must include UBI numbers.

28. Will alcohol be:

    1. Served
    2. Sold
    3. No alcohol will be present
29. Name of organization/Person that holds WSLCB license

    Must obtain a permit from Washington State Liquor and cannabis board a copy must be provided  

31. Click on the link to obtain your liquor permit
    Washington State Liquor and Cannabis Board
33. Name of MAST Certified Server

    If serving alcohol and 150 or more attendees, a MAST Certified Server is required and a copy of their card will need to be provided.

34. Name of 3rd Party Security Company

    If serving alcohol and 150 or more attendees, a 3rd Party Security Company is required and a copy of their contract will need to be provided.

36. INDEMNIFICATION AGREEMENT:

    RENTER AGREES THAT AS PART OF THE TERMS OF THIS AGREEMENT, RENTER ON BEHALF OF HIMSELF/HERSELF/ITSELF AND HIS/HER/ITS GUESTS, HEIRS, BENEFICIARIES, EXECUTORS, ADMINISTRATORS, INVITEES, ASSIGNS, LEGAL REPRESENTATIVES, AND ANY PERSON PRESENT AT THE FACILITY AS A RESULT OF RENTER’S EVENT AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE CITY OF FERNDALE AND ITS APPOINTED AND ELECTED OFFICIALS, OFFICERS, REPRESENTATIVES, AUTHORIZED REPRESENTATIVES, EMPLOYEES AND AGENTS FROM ANY AND ALL DAMAGES, LOSS, COSTS, CLAIMS, AND EXPENSE OR LAWSUITS FOR DAMAGES OR LIABILITY, INCLUDING ATTORNEY FEES IN DEFENSE THEREOF FROM PERSONAL OR BODILY INJURY, INCLUDING DEATH AT ANY TIME RESULTING THEREFROM, SUSTAINED OR ALLGED TO HAVE BEEN SUSTAINED BY ANY PERSON OR PERSONS ON ACCOUNT OF DAMAGE TO PROPERTY, ARISING OR ALLEGED TO HAVE ARISEN DIRECTLY OR INDIRECTLY OUT OF OR IN CONSEQUENCE OF THE RENTAL OF THE FACILITY AS PER THIS AGREEMENT.

    USER AGREES BY HIS/HER/THERE SIGNTURE ON THE FACE HEREOF THAT HE/SHE/THEY HAS READ AND IS AWARE OF THE TERMS AND CONDITIONS CONCERNING THE USE OF THE FACILITY AND ACCEPTS FULL RESPONSIBILTY HEREIN.

38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field