FUNDRAISERS ON CITY STREETS
APPLICATION
| ORGANIZATION: | |
| APPLICANT NAME: | |
| APPLICANT PHONE: | |
| APPLICANT EMAIL: |
| INTERSECTIONS: | INTERSECTIONS: | ||
|---|---|---|---|
| (EXAMPLE) | TEMPLE / MAPLE | / | |
| / | / | ||
| / | / | ||
| / | / | ||
| / | / | ||
| / | / | ||
| DATES OF EVENT: | TIMES OF EVENT: |
|---|---|
| (EXAMPLE) 03/18/2023 – 03/19/2023 | (EXAMPLE) 9 AM – 5 PM & 9 AM – 12 PM |
ILLINOIS DEPARTMENT OF TRANSPORTATION APPROVAL (400 W. WABASH AVE.)
(Only applicable for State Highways):
APPROVED BY:
, IDOT
DATE:
I, _______________________________, acknowledge that I have received a copy of Effingham City’s Safety Guidelines
for Fundraising on City Streets and will review safety guidelines with all fundraising participants prior to event start.
APPPLICANT’S INITIALS:
DATE:
Approved By:
| MAYOR’S OFFICE | DATE: | |
|---|---|---|
| INSURANCE AND SAFETY | DATE: | |
| POLICE DEPARTMENT | DATE: |